Julian’s Most Simple Rule: How To Get Better With Tinnitus – Julian Cowan Hill – #11

Julian Cowan Hill shares a simple rule that he uses with his tinnitus clients to help them get better. Dr. Ben Thompson interviews Julian about this method and his new app Quieten. Come take a listen and learn from one of the most influential tinnitus therapists in the world.

Full interview with Julian Cowan Hill about tinnitus management techniques.

Ben Thompson, AuD

Welcome to Episode 11 of the Pure Tinnitus & Hearing Podcast. This is your host Ben Thompson, founder of Pure Tinnitus. Today we are here with Julian Cowan hill from London, England. Julian has become a good friend of mine and a mentor. Julian has the most popular tinnitus therapy YouTube channel, and he’s helped people from all over the world with their tinnitus. Julian, explain to us who you are and what you do for the tinnitus community.

Julian Cowan Hill

I’m somebody who had tinnitus myself. I had it for 20 years quite badly, and cranial sacral therapy, something that I’d never heard of before, as a last desperate attempt, I tried it out, and it had a huge impact on my tinnitus and I fell in love with this way of working and started training. And after about a year and a half into this training course, I experienced silence for the first time.

Julian Cowan Hill

Which was like a miracle after 20 years of extreme, really horrendous symptoms.

Julian Cowan Hill

And while I was training, I set up a student practice working with tinnitus clients, and I’ve been very busy ever since. And I’ve been running a practice in central London, doing cranial sacral therapy. And I’m also a trained psychotherapist and I do quite a lot of tinnitus counseling. I have clients all over the world who call in and ask for some advice for that, learning techniques and practices and, and reassurance. I give a lot of reassurance that people can get better and help people get on track to recovering.

Ben Thompson, AuD

You know that I first found out about you when I was working in Hawaii at a clinic and a patient of mine who had very bad tinnitus came to me and they said that they were finding help through this guy named Julian on YouTube. And of course, as an audiologist, when someone says they found someone online for tinnitus, my first thought is a scarcity-based thought of, “Who are they? Do they have credentials? Are they a trusted source?” Because we don’t want someone online to go down the wrong path of that kind of fear-based tinnitus work. But then I looked into the YouTube channel and I saw the massive following and the techniques that were being taught. And now here we are a few years later. So that’s my first introduction to the work that you do, from that patient of mine. Really happy that you’re here. Thanks for coming back on. I know that you had been featured here on the YouTube channel with the tinnitus virtual summit, and a lot of people enjoyed that summit. What I wanted to talk about you and I had been having a conversation a few minutes before this recording about what would be helpful for us to talk about here. And we decided that let’s talk about something that’s relevant to your tinnitus patients, people who are coming to you for tinnitus, a common theme that tends to come over, over and over again in recent times. So acceptance versus getting better. How does this all happen? What is the acceptance process for someone with a case of tinnitus, that’s not related to a medical cure or treatment? Acceptance vs. getting better? How does this all make sense for us.

Julian Cowan Hill

Well, a lot of people are attracted to the whole notion that you can’t get better with tinnitus, especially after you’ve been online. And there’s so much negativity out there. And it can be very distressing and really scary and lead people in a very bad way. So somebody like me, who says, Well, no, actually you can get better, can come as a bit of a shock to people. And they can almost get overly enthusiastic about getting better right from the start, and they want to experience silence, right from the very beginning. And with tinnitus, it’s a little bit of a journey. Silence can happen. We can move from seven out of 10 down to five out of 10, you start hitting silences, and you start resting in silence again. But what often happens is that people really latch on to silence and they want to get better immediately. And they can end up fighting the tinnitus and fighting their symptoms and getting really frustrated and impatient. Which of course keeps the whole thing going. Tinnitus loves impatience and anger, it’s a very reactive symptom. So all the fight or flight responses and you know, when we get really impatient senior that pushes our stress levels up and, and if we become quite aggressive to ourselves and give ourselves a hard time, you know, actually that’s very stressful for the nervous system. And we want to do the opposite. We want to become friends, we want to look after ourselves, you want to release, let go and settle. So a very good place to start and a really good kind of landing place a good stepping stone in the right direction is acceptance. Accepting that it’s here, and being with it, learning to hang out with it, instead of fighting it. So an image that I always have is having tinnitus. It’s like having us a smelly tramp moving into your flat and you just don’t want them they’re just like, get out, leave me alone, who the hell do you think you are. And, and if you get into big arguments, it can get really nasty and your tinnitus can really flare up. But if you start learning how to self-soothe and settle, which is a lot of what I teach and help people, if you can actually get a nervous system to calm down and release and come back to a much more comfortable state of homeostasis. And then the symptoms tend to pipe down. So the first stage is really learning how to let it be here. And to find manageable ways of being with it. So instead of just living in your head and fighting this thing, and it’s a very tight and tense bubble of experience, and tinnitus that looms large, it’s like a big fish in a tiny pond. What I do try and help people to really connect to a much calmer, much bigger experience and the whole body where they can focus elsewhere. And calm down and settle. And the tinnitus then becomes much more manageable. And you can let it be here. It’s here, for now, it’s not here forever. At the moment, it’s here. These are my reactions to it. This is what I’m feeling with it. And these are the practices or techniques I can use to calm myself down. These practices and techniques are hugely helpful because it just makes everything more manageable. And the tinnitus just becomes part of a much bigger experience. It’s not taking over, it’s not dominating. So, you know, I have clients who suddenly realize they’ve been fighting for years. Absolutely. for months and months as well.

Julian Cowan Hill

Then they realize that absolutely, you know, they need to give up the fight. And they need to just relax a bit and stop. Stop trying to pretend it’s not there. An analogy for this which I’ve I’ve used is when I’ve I went to live in Venezuela for a year. And opposite my flat, there was a reptile house in the park and I was terrified of anacondas and snakes. And so when I first went, there was this giant Anaconda there and I was just absolutely terrorized but I went back often. And I kept on revisiting the Anaconda and over a period of time my fear came down. And I was able to by the end of the year think it was a very beautiful snake and be a bit fascinated by it. And, and so just allowing myself to be with my feelings, and to accept them. I could feel fear, I could see the Anaconda, and then I’d go away. And I kept on going back and it helps me really accepted over a period of time. It’s a really crucial thing on the path to getting better.

Ben Thompson, AuD

When you talk about acceptance, some thought I have is about masking. In the audiology community, we focus a lot on sound therapy, which can be very helpful. And sometimes that’s using sound from a speaker, natural sound outside, or sometimes devices on your ears to play sound therapy. And this term of masking I feel is psychologically training us to cover the tinnitus, to hide it, to mask it, to cover it. What are the most common ways that people fear tinnitus or try to cover it up? And this can happen in the mind or this can happen with the actual sound? What do you think about that?

Julian Cowan Hill

Well, people can build up a whole load of things that put tinnitus center in their life. They’ll spend the whole day structuring themselves around managing the sound environment the whole time, going to bed, and listening to this all night long. And being afraid of bedtimes because it’s quiet to sleep. And it can get us into a very stuck place actually. Because I think it’s a much more successful approach to put well-being center stage and to actively get help to, to drop into states of well-being or to do practices that bring in well-being. I think it’s much better to normalize one’s life, and listen to the radio or listen to the music. I know masking is incredibly helpful, especially at the beginning. And tinnitus retraining therapy is the principle of it, you have the tinnitus and you have the masking sounding over a period of time, you can bring both down. And I think that’s really helpful. At some stage, we want to leave our hearing alone, we want to take the attention away from it. So watching a good film, or listening to the radio is going to be much more interesting. Once you get involved in a film or listening to a radio play or a news bulletin. When you get interested in the contents, you’re going to start forgetting about your tinnitus because you’ll be wanting to hear the message and the information, you’re not going to be focusing on how you’re listening to it, you’re going to be interested in what’s being said, which is hugely different. So, you know, I’ve often encouraged people to listen to audiobooks or to listen to the radio or to listen to music. Because they would normally, it’s interesting, it’s captivating, and if the content is safe, by that I mean it’s comforting and life-affirming. You don’t want to be listening to doom and gloom on the news all the time or watching horror films when you’ve got tinnitus. Because it is triggers you and put you even more into a scared fight or flight response. You want life-affirming, nourishing, kind, comforting input, hugely important and that helps your nervous system settle, listening to normal everyday things, normalizes your hearing experience, and helps you forget about tinnitus. And you can suddenly just get lost in the film or listening to a piece of music. And you literally forget all about your tinnitus. And that’s very helpful. That’s when it can fall away or come right down.

Ben Thompson, AuD

I’m working in our group program right now and one theme that has to come up, which is similar to the research protocols that also help military veterans in the US and tinnitus retraining therapy is to try to avoid very silent places by having some sound enrichment around us and also to try to be mentally stimulated. And with when both of those things are set up. It’s creating an environment, internal and external, that makes you less likely to go into a downward spiral, to go into a dark place, focusing latching on to the tinnitus. I wanted to discuss what I feel like you’ve brought to this community and been the pioneer of is understanding that the nervous system. You’ve broken down the nervous system into a functional body-based approach. And most audiologists, psychologists are staying up in the head. And only the yoga teachers, physical therapists, craniosacral therapists, and people teaching meditation are bringing some of that attention down into relax the nervous system of the physical body, and they feed each other. The body, when it’s relaxed can tell the mind I’m in a relaxed state. And that can have a positive effect on the tinnitus. I have been focusing a lot of my attention with the clients I work with, on that, whether it’s meditation, relaxation practices, and anything else that we can do to feel more relaxed and healthy in our body. So how did that all start for you? I know that your cranial sacral work was part of it. But how many patients did you have to work with before you realized okay, this will only work for me this works for others too…

Julian Cowan Hill

As a student, cranial-sacral therapist, I put a sign-up and said “I’m a student looking for guinea pigs with tinnitus. I can charge a reduced rate, are you interested?” I was full. I just got loads of people coming. And so I was really lucky in that way. And, and I was very enthusiastic because cranial work was helping my tinnitus so much. People, commonly have ups and downs with tinnitus, but they started to feel themselves relaxing very deeply, which is wonderful. I mean, cranial work is, when it’s just right, it’s just fantastic. You just find yourself on the couch, just kind of slowing down, melting into the couch, and the thoughts slow down and just feel everything going very calm and peaceful. When you drop people into stillness because you’re feeling this, when you feel a whole person, just really filling out into the whole body and just settling. It’s such a lovely experience as a therapist, it’s a real privilege to feel the whole body eating is like the whole room goes calm and quiet. Frequently, people say, gosh, you know, the intensity is gone down, or, it’s gone quieter. Oh, you know, I haven’t thought about it. And they started having experiences much like I’d had you guys very lucky. In my very first cranial session, my tinnitus really changed a lot and I was a bit freaked out actually, it was such a shock after years of feeling locked in and imprisoned in this thing. So quite quickly, I felt that the cranial work really could affect the nervous system and the auditory system. And I just talked about it, I wrote about it, and people are interested and then colleagues got wind of this and they were practicing. And I’ve been quite outspoken about cranial work helping tinnitus and, and the YouTube channel that I’ve got has kind of generated quite a lot of interest in cranial work. So thankfully, there have been lots of referrals all over the world. And, you know, people get good results. And by good results, you know, people can start off with like a seven or eight out of 10. And then three or four months later, they’re down to a two or three out of 10. And maybe a year later, they’re having regular zeros, zero point fives you know, it’s not a quick fix. Cranial sacral therapy, it’s more like a gradual easing off of symptoms. You have the idea that you have one session a week, once a week, and you just keep going and gradually everything eases off. So it’s quite clear to me when I set up a practice that cranial work definitely helps. And learning about anatomy, physiology, and how the nervous system responds. You know, the role of a therapist is to make a client feel very safe and to help the body really feel deeply safe, and you learn how to do that. And you bring the whole nervous system into balance. And so it just becomes very obvious from experience if you, if you speak to any body-based practitioner, whether they’re a reflexologist, massaging the feet or Shiatsu practitioner, it’s like acupuncture, but with fingers. After a few years of practice, they just know how it benefits people.

Julian Cowan Hill

In Britain, for example, it’s all private practice. And so people have to pay for sessions. Normally, in Britain, people go to the National Health Service, we’re very lucky to have a really good National Health Service here. So if you’re a private practitioner, you got quite a lot of competition with the normal medical health route. So the good results speak for themselves and we all get busy because people benefit and then that generates referrals. It becomes quite clear.

Ben Thompson, AuD

You’re doing great work with that. And a lot of people who I’ve met have tried craniosacral therapy and from my perspective being in the hearing domain, we must remember that not all tinnitus is created equal. So what was the cause of tinnitus may be different for Julian than it would be for someone listening. And from my perspective, stress-induced tinnitus, anxiety, depression-induced tinnitus is probably the best kind of tinnitus to go down this body based route, with relaxation techniques, getting out of the mind, relaxing into the body. It’s probably a very good factor to say yes, you’re likely to have success with this. And someone who has a significant hearing loss, damage to the ear, they may have loud tinnitus without being stress-induced, anxiety, or depression. But if that person with loud tinnitus notices that they’re having a tinnitus spike or a period of time where it’s gotten a lot louder, that likely is related to that nervous system in the body. So I wanted to bring this in because not everyone with loud tinnitus is going to see good results with a body based approach in terms of the loudness reduction.

Julian Cowan Hill

It’s a really good point. I’ve worked with a lot of musicians and filmmakers and people who make a lot of noise for a living. And clearly musicians, you know, it’s their livelihoods. And they get very distressed when the hearing is impaired with tinnitus. So if they have an explosion, or sudden blasts of sound that damages their hearing, and have a real drop, they become deaf, and frankly, you really can damage your hearing with loud noise, we all need to be so much more careful with loud noise. If you damage your hearing, tinnitus appears as a compensatory response by the brain. But that tinnitus is nervous. It’s a set of nervous information that’s kind of going in a loop, it’s just going round and around in circles. And if we latch on to it, and then get afraid by it, it can kind of make it worse. What I find working with hearing damaged tinnitus, sound induced tinnitus, is that the cranial work can still help release the buzzy charge. It’s like you bring the whole activation levels down. And when people get into a switched-off state, at some stage, the brain can decide that this information is not important and throw it out. This is what I’ve really learned over the last sort of five years. It’s really emerged clearly that we have functions in the brain to inhibit the perception of sound, which means it gets switched off. A really good example of this is falling asleep in front of the TV. You got tons of noise coming in screaming, shouting ambulances, sirens, gunshots and people because they’re just switched off and relax on the couch at home. They fall asleep, and the brain completely ignores all that noise. Yeah, so all I’m saying when you’re on the couch asleep, your brain is ignoring all that sound. If you call the person’s name, bam, you wake up, your brain knows that your name is important. It’s important enough to wake you up from sleep. Whereas all that sound that’s coming from the TV is irrelevant, because you can switch it off. It’s not dangerous, you don’t care about it, so the brain can ignore it. So when we have a buzz or sound in our head, and we freak out about it, we give it a tremendous amount of importance, and that keeps it firmly plunked in the center of our awareness. And if we put fear and anxiety on top of it, that can really lock it in. So I found with hearing damage, tinnitus, if I drop somebody into a deep state of calm, and I work with the kind of buzzy charge, you can palpate this with your hands, it’s like literally feeling vibrations and pulsations in the person’s temporal region. Hanging out with that you can help it dissipate. And when people drop into a very deep state of calm, the sound quietens down, it’s like it drops below the threshold of awareness. And once people start experiencing it quietening down the whole relationship, but it changes it becomes less threatening. So even with the most fixed hearing damage, tinnitus can still shift. It is different to people who are depressed or stressed out. But it takes my experience maybe a little bit longer. And people’s mindsets and more.

Julian Cowan Hill

I’ve got damaged hair cells. If you think about it, the residual sounds is still just brain buzz. And your brain can ignore a powerful heartbeat most of your life you know, you’ve got a cardiac pulse in your head, you got a great big booming drum in the middle of your chest and you don’t hear it because your brain is ignoring it. There is sound there but your brains filtering it out. I think this is a really crucial area to work in tinnitus. If I think about your case, if you have a cup of coffee in the morning, you can taste it in between breakfast and lunch. You don’t taste anything because it switches off. So much of our sensory world switches off and goes into screensaver a lot of the time and only switches on when we need it and use it so tinnitus doesn’t really matter once the trauma is over once everybody’s got used to the tinnitus being here, if it’s from an anesthetic or allowed bomb explosion or from stress, once I’ve settled into the tinnitus, that tinnitus can still fall away. I’ve worked with a lot of people with sound damage tinnitus and it does back off. People that have had operations to remove growths on the auditory nerve, people’s nerve has been severed by gamma knife surgery. People who have been a car crash and they’ve had some lesion and it’s caused instant tinnitus overnight. Even despite these very traumatic situations, the nervous system can be encouraged to become quiet and then start filtering out all of that stuff.

Ben Thompson, AuD
So there’s room for improvement there and part of it is learning the nervous system. The hearing in the brain gets input and feedback from the non-auditory pathways, which are related to the physical body and feeling calm, centered, relaxed, grounded. And cognitively understanding where you are at in the journey, and that most people do get better. And the sound itself can change over time. Those two factors combined are really what you and I probably hammer home to all the patients we work with, right?

Julian Cowan Hill

Yes, when you have a good understanding, it kind of makes sense. You know, people often send me emails saying, I’ve watched your videos and it really makes complete sense to me. I kind of get it now. And, and so it becomes less threatening, it becomes less scary. And when the fear comes down, the first thing that happens is that the nervous system can stop being hypervigilance. And you come out of that, and that causes the senses to settle. Yeah, I mean, I’m severely deaf in my right ear and moderately deaf in my left, and I damaged my right ear in front of a loudspeaker. I got tinnitus overnight. And it took me about seven weeks of hard work, it was hard work to get back to silence. You know, I knew what to do, I was very experienced then. And now I’m so completely used to my ears being the way they are, I never think about them. I tend to find myself walking with the person on the left-hand side if we’re talking. I have my sort of habits, but I don’t mind, I’m not aware of my ears, and I’m not monitoring them, they’re comfortably settled into their new state. And I think that’s crucial for, for getting better. You know, there’s a lot of hyper-focusing and, you know, constantly being overwhelmed. And, for me, I think we need to leave our hearing alone, to seeing an audiologist, it’s great to get everything working and functioning to the best, you know, hearing aids can be amazing. And maskers can be very helpful. Once they’re in place, then people need to really let them work and then forget about barriers. They want to just relax. They want to just get back into normalizing their life and focusing on things that are more interesting.

Ben Thompson, AuD

Absolutely. And that’s a great way to frame that. First to get the medical conditions checked out, have a plan, have some therapy or treatment. And then it’s a longer slower journey of how do I make myself feel better in the mind, in the body, with my health, nutrition, sleep, mindset, and with my psychology. I know that you’ve worked very hard on your YouTube channel, which has been around for a long time and helping millions of people, or at least getting millions of views. How does someone find you, either on YouTube or another way? And you’ve been working hard for the past few years on this app called Quieten. Explain to us what we need to know about how to possibly find more material from you.

Julian Cowan Hill

Yeah, I mean, Quieten is an app that I put on the smartphone system. When you open it up, it’s basically a whole list of videos and you can look at different levels of help: I just got tinnitus, What should I do, or basic techniques on how to let go of tinnitus. So for example here in the basic techniques, you got what an evening facial massage, to show you how to do basic facial muscles, so you just click on the video and it basically talks you through how to do things. The app quieten is designed to give you many different perspectives and to teach many practices and to give you a toolbox of have all sorts of different things to try out to find out what works for you. And it charts people through a map of getting better. I wrote a book called tinnitus: from tyrant to friend and it has a matrix in the middle of it and at the bottom of the matrix is where people are really struggling. They’re stuck connecting.

Julian Cowan Hill

Oh my god, I can’t get out of tinnitus. And the mindsets for a fixed, there’s no hope for me they feel trapped. And as you work up, you can tinnitus can really become like a friend where you know what makes it better, you know what makes it worse. And you know how to look after yourself. And this gives people a sense of a path to follow. And so my app quieten is very much about that journey of getting better helping people learn techniques and practices. There’s lots of reassurances on there. So you can listen to audio files, or you can watch videos, which is helping people develop a positive mindset, and an understanding, which helps people feel less afraid. It’s gained from hard experience from myself and working with over 1000 clients over the last 20 years. So it’s an app that people can watch in the middle of the night if they’re freaking out. It’s very helpful to just watch a video and kind of hear from somebody who’s been through the same thing. Hopefully, you can learn from it and you can feel reassured and you can start to understand how it works. And you can then develop your own tools to cope and to help your system settle. So there’s a lot of techniques on self-soothing, you know, simple things like yawning and facial massages are hugely helpful. You know, yawning is the natural way of destressing the ear, nose, and throat system. That little auditory muscles quiver and release when you hear that. And you can hear the clicking of eustachian tubes and massaging will open up blood circulation and cerebral spinal fluid flow and get the function of your ears into a much better place. So those little bones that transmit the vibrations from the eardrum to the cochlea have plenty of suspension and space to vibrate and transmit sound freely. Not in the distorted way. And the actual ears themselves and the whole area need to feel comfortable, and kind of relaxed. All of these things help and so I basically bundled all the things I’ve learned together into that one app, quieten. And I’m also collecting positive stories from people who’ve got better and putting it into there because hearing from other people who’ve got better hugely helpful, very reassuring and inspires people to take better care of themselves and learn how to de stress and settle.

Ben Thompson, AuD

Thank you Julian for coming on. It’s been a pleasure to host you as always and to hear what’s going on in your life, helping your patients with your private consultations as well as your app. I know we’re gonna be collaborating in the future at some point. This is episode 11 of the Pure Tinnitus & Hearing Podcast with our wonderful guest all the way from London, Julian Cowan Hill. Have a nice one, Julian.

Dr. Ben Thompson, Au.D.

Dr. Ben Thompson, Au.D.

Dr. Ben Thompson is an audiologist in California and founder of Pure Tinnitus. Dr. Thompson has a comprehensive knowledge of tinnitus management. He completed his residency at University of California at San Francisco (UCSF) and is a past board member of the California Academy of Audiology. Via telehealth, Dr. Thompson provides services to patients with hearing loss and tinnitus.

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