Explore Reactions to Challenges

Exploring hearing loss challenges in a group setting can convey to the participants that certain problems are frequently associated with hearing loss and are not due to personal inadequacy or inability.

Hearing impaired persons and their communication partners will react to communication difficulties as they occur. Reactions may be in one or more of the following domains: behavioral, cognitive, emotional, physical or interpersonal reactions.

Some reactions to difficulties are functional. They resolve the problem and, perhaps prevent its recurrence. Other reactions are dysfunctional; they do not resolve the problem and often make the situation worse.

To reduce dysfunctional reactions, it is helpful for group members to understand the broader effects of hearing loss.

Hearing Loss as a Systems Issue

The Concept

Hearing loss can be considered a systems issue affecting much more than just the auditory mechanisms. Internal and external effects of hearing loss can have a profound positive or negative influence on treatment effectiveness as well as on a person's quality of life. 

Difficulties related to hearing loss can be divided into two categories. The first category pertains to external factors such as social relationships and physical environmental factors. The second category pertains to internal factors, such as what is going on inside the person who has the hearing loss and his or her communication partner prior to and during communication attempts.

The External Environmental System

Hearing loss affects an individual's ability to receive and correctly interpret environmental sounds. These sounds are important for physical safety, such as sirens, whistles, fire alarms and radio alerts. Other sounds are an essential part of every day life, such as alarm clocks, telephones and doorbells.

Difficulty hearing or responding to these sounds can result in elevated and chronic discomfort leading to emotional reactions such as anxiety, fear or anger.

Interactions Between Macro and Micro Systems

Interactions can happen when one is aware of difficulty understanding important information being said.

For example, the inability to hear sounds at the business meeting (macro) produces even more anxiety/fear (micro). The anxiety (micro) makes it difficult to use sound judgment and problem-solving strategies (micro processes), which further increases her inability to understand what the others are saying (macro) at the meeting and prevents effective problem resolution. 

This results in a further increase of anxiety. In the future, the individual may begin to feel ill the day before such a meeting. She may have to take off the day of the meeting or perhaps find reasons to look for another job.

The External Social System

Hearing loss is basically a communication disorder affecting everyone in the communication situation. Both the person speaking and the person listening can contribute to communication breakdowns. The cooperation of both is necessary for preventing or reducing communication difficulties.

Both the speaker and listener will react to communication problems when they arise. How they react will influence whether the communication problem gets resolved, remains the same, or worsens.

Internal Emotional-Physiological Factors

This refers to feelings resulting from communication difficulties, such as anger, anxiety, fear, depression, embarrassment, shame, and/or guilt that influence attitudes and behaviors.

Underlying these feelings are physiological processes, such as neural, hormonal, cardiovascular and immune activity.

These responses serve a useful function in acute situations, but are detrimental to health and well-being when chronically aroused. Negative emotional arousal and its attendant physiological reactivity are often caused by communication and other problems related to hearing loss.

Internal Cognitive System

Unrealistic, dysfunctional attitudes and expectations contribute to ineffective behavior and often precipitate negative emotional arousal.

For example, an individual who holds the belief that she will not be able to understand what is said in an upcoming business meeting will likely feel anxious. This will then interfere with cognitive functioning, such as thinking, judgment and problem solving.

Due to the combination of anxiety and reduced cognitive ability, the individual in question will probably not make an effort to take action  so that she can better understand what is being said during the meeting.

Must Reads

MacDonald, G. & Jensen-Campbell, L.A. (2011). Social pain: Neuropsychological and Health implications of loss and exclusion. Washington, DC: American Psychological Association.

Nachtegaal, J., et al (2009). The association Between Hearing Status and Psychosocial Health Before the Age of 70 Years: Results From an Internet-Based National Survey on Hearing. Ear and Hearing. USA, Lippincott Williams & Wilkins.

Knutson, J.F. & Lansing, C.R. (Nov. 1990) The Relationship Between Communication Problems and Psychological Difficulties In Persons With Profound Acquired Hearing Loss. J. of Speech and Hearing Disorders, vol. 55, 656-664.