Emotional reactions related to hearing loss often underlie dysfunctional attitudes and behaviors that cause or contribute to personal and social problems. Helping group members identify these reactions can help them prevent or reduce difficulties in the future.
As a Group AR leader, it is important that you have a good understanding of the various emotional reactions participants often have with their hearing loss. With this understanding, you can lead a discussion about constructive ways to deal with such reactions, offer words of encouragement, and possibly advise participants to seek additional counselling.
Emotional reactions to threatening or dangerous situations are basically survival mechanisms. Out in the wild, these reactions often needed to be spontaneous and fast-acting. If they were too slow, an animal could find themselves in a dangerous and precarious situation. To ensure a fast reaction, survival mechanisms are mediated by brain areas that function below the level of conscious awareness.
In modern times, most of the situations that elicit negative emotional reactivity are in reality benign or non-life-threatening. As these dysfunctional, negative emotional reactions become habitual, they become resistant to change.
What is anxiety?
All living beings have sensory systems. They help identify environmental signals that should be approached or avoided. When this information is weakened or missing, a natural increase in physiological processes (anxiety) develops. This keeps the organism in a heightened state of awareness to compensate for the missing information.
Anxiety is a frequently observed emotional reaction to difficulties related to hearing loss. Having a sense of influence or control over environmental events requires, at minimum, information about what is happening out there in the environment. Feeling out-of-touch with one’s environment often results in heightened anxiety due to the inability to hear or locate the source of important environmental information, such as alarm signals, door bells or telephones.
Hearing Loss and Cultural Stigma
Another source of anxiety is the awareness of and buying into the negative, cultural stigma surrounding hearing loss. Some people attempt to hide their hearing loss. They believe that others look down upon hearing impaired persons. Initially, there is some fear or anxiety related to the fact that one has a devalued characteristic and may be seen and treated as being unacceptable. On top of that is the fear that one might be singled out or labeled. This causes the attendant anxiety to increase.
When one attempts to hide a hearing loss, she or he probably will not discuss hearing loss related issues with others. They may not own or wear hearing aids for fear of being discovered. The individual is then prevented from learning what to do to accommodate the hearing loss. So, any problems stemming from the hearing difficulty have no way of getting resolved. To compound matters, anxiety interferes with paying attention to information from the environment. This increases the likelihood of not understanding certain discussions.
Increased Sensitivity to Negative Stimuli
Our emotional memory system operates extremely rapidly and below the level of conscious awareness. It can be triggered by stimuli associated with a previous or pre-wired threat or painful event. If one has experienced being seen as foolish or incompetent due to an embarrassing communication error, that event registers in one's memory system.
Cues in future situations that are similar to those in the past event can elicit similar emotional reactions. If this happens, the person can experience anxiety in a new, non-threatening situation and not have any idea what is causing the disturbing feeling.
One can also develop anticipatory anxiety before going into a similar situation in the future. Some people develop feelings ranging from apprehension to dread about going to certain events. This sometimes results in the inability for an individual to leave their own home. People with hearing loss frequently report having stopped engaging in certain activities such as going to restaurants, playing cards with friends, or attending family gatherings.
These various sources of fear and anxiety can lead to a debilitating condition known as social anxiety. This causes the person to react with moderate to extreme discomfort in social situations. In a serious case, the person may avoid social interactions altogether and isolate themselves.
The causes of social anxiety range from seemingly minor embarrassing mistakes, such as misunderstanding what someone says, to a major life change, such as losing a job or a divorce. Social isolation itself produces a variety of negative consequences such as loneliness and depression.
Social Isolation and Broader Effects
One of the major problems with isolating oneself socially due to hearing loss is loneliness. This can result in depression and increased morbidity and mortality.
Lonely people are often sicker and die younger than people who have frequent social contact and support. Depression depletes energy. It reduces motivation to make necessary life changes to feel better.
Being alone also deprives persons with hearing loss to learn and practice more effective communication strategies and behaviors. It deprives them the chance to learn that other people's reactions to communication breakdowns are benign. They are usually neither threatening nor dangerous.
Depression often robs the individual of the energy necessary for taking steps to improve their quality of life. When people are depressed they are prone to see events from a pessimistic perspective, selecting and remembering negative aspects of a situation and disregarding the positive aspects.
Losing Something Valuable
Some people have truly lost something of great value to them due to their hearing loss. This could be a person who loves to listen to music and is unable to hear it in the same way as before. Others have lost valued relationships or their career.
Consider this example from a Group AR session. One gentleman stated that he had finally risen to a very high position and salary in a large national corporation when his hearing diminished to a point where he found it difficult to communicate informally. He resigned because he felt that at his position in the company, most of the important information is conveyed informally. It was unfortunate that he knew next to nothing about what he could have done to successfully maintain his position.
No Effort to include me
Sam Trychin listens to a participant who has been excluded from activities throughout her life. During your Group AR program, be prepared to listen as participants describe how hearing loss has affected them emotionally and offer participants positive words of encouragement.
Irritation and Anger
Humans need social contact. We depend on others for survival during our early, and often later, years. The threat of losing social attachment is a powerful motivator for taking steps to repair any damage to a relationship one has caused.
Embarrassment, shame, or guilt are pre-wired reactions that we have when we make a social blunder of some type and are aware of it. This can occur when a person with hearing loss is called out on bluffing for the last 10 or 15 minutes.
Embarrassment results from minor transgressions of social rules or mores. Shame results from the perception of a major transgression. Both embarrassment and shame result in visible signals that the transgressor is aware of his mistake and is repentant. Blushing, eyes cast downward and rounded shoulders are some of the visible signs of embarrassment and shame that serve the social function of eliciting forgiveness and otherwise repairing the damaged relationship.
Guilt arises when an individual becomes aware that she has caused harm in some way to another individual. Uncomfortable feelings of guilt motivate the transgressor to do something to make amends to restore the situation to where it was prior to the damage. People who don’t exhibit these visible signs of distress following transgressions are often seen as being rude, uncaring, or hostile, resulting in their further alienation.
People can also experience irritation or anger when frustrated or blocked in attempts to achieve a goal, such as understanding what others are saying on TV, in-person or on the phone.
Anger is sometimes a cover up for fear. The person feels less distress when angry than when feeling fearful or anxious. Anger provides some sense that one is in control, while fear or anxiety can produce feelings of helplessness.
Whatever the source of the anger, it is inappropriate in most situations. It stimulates others to become defensive or to fight back, neither of which are helpful in problem-solving attempts.
A basic component of shame is the perception that one is damaged or basically unworthy in some way that cannot be fixed. For example, "I am being seen as incompetent or unacceptable because of my hearing loss, and I cannot change the hearing loss, so that's not fair."
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.