10 – Hearing Loss and Stress

There are prewired physiological and psychological reactions to threat or danger that prepare people to take action to deal with the situation. Emotional arousal is a major component of the reactions to threatening or dangerous events. This arousal is a major component of the body’s built-in adaptive resources that allow an individual to take action to deal with the threat.” Emotional arousal involves neurotransmitter secretions and hormonal reactions that mobilize the body’s resources. In the short-term these reactions are useful and beneficial, but when emotional arousal is too intense or prolonged, cognitive functioning is interrupted and the integrity of the body is damaged, leading to health problems.

Normal Arousal and Stress

In normal day-to-day functioning people usually go through many cycles of:

The balance between the two is known as homeostasis, equilibrium or coherence. When emotional arousal becomes unduly frequent or intense and unmanageable, and there is not a fairly rapid return to the body and mind resting baseline functioning, we are in state of stress. Stress arises in response to external situations and events and also in response to internal emotional and cognitive processes, e. g., memories, attitudes and beliefs, which may persist in the absence of any external stimulus.

Some frequent causes of stress are conflicting demands, time pressure, and adverse social situations. In regard to the latter, intra-familial abuse or neglect is increasingly recognized as producing complex posttraumatic syndromes, which involve chronic emotional dysregulation, destructive behavior against self and others, learning disabilities, mental health problems, physical health problems, and distortions in concepts about self and others.

Two major aspects of functioning to consider related to stress are the immediate reactions to stress, and the storage and retrieval of memories relevant to stressful situations. In regard to the social pain resulting from some form of rejection or social disconnect the emotional reaction can be experienced at the same magnitude by:

People who have hearing loss are at risk for experiencing all three of these triggers of emotional reactivity. A major challenge for service providers is finding ways to reduce the emotional reactivity — anger, anxiety, depression — that accompanies intense or prolonged social pain experienced by their consumers or patients. The distress produced by some form of alienation motivates people to escape from or avoid getting into situations that are associated with it. Withdrawal in any form precludes the person’s ability to practice effective communication tactics and strategies that, in the longer run, prevent or reduce the experience of social pain and the accompanying emotional arousal. Additionally, high emotional arousal interferes with the verbal areas of the left hemisphere of the brain, causing difficulty in thinking clearly, making decisions, planning a course of action and otherwise using good judgment.

VR Professional Questions

Why provide hearing aids and other assistive listening devices and why train a consumer to pinpoint the causes of communication breakdowns and offer solutions for them if that consumer becomes so upset in social situations that she/he can’t effectively use them? Why provide the technology and training to a consumer who has become so emotionally reactive in social encounters that she/he regularly avoids social situations? Might it not be better to address the emotional arousal first?

VR Professional Solutions

It is important, then, to assess the level of emotional arousal experienced by consumers who have hearing loss when they are in difficult communication situations. The Ida Dilemma Game can be a useful model for getting a general sense of a consumer’s emotional reactivity to situations that depict someone with hearing loss having a communication difficulty. The VR professional might develop one or two relevant employment situations and ask the consumer to talk about his reactions to the situations and how he would handle it. It is also very useful to have consumers recount recent situations in which they experienced some form of social difficulty resulting from hearing loss-related problems.

In this regard, there is benefit gained by conducting groups of consumers who have hearing loss and, when possible, their communication partners. One of the major benefits of conducting groups is that participants’ emotional reactivity usually becomes evident during sessions and can be addressed immediately by offering strategies for reducing communication problems and discussing strategies for managing emotional arousal.

In any case it is necessary to inform consumers about the relationship between emotional arousal and physical health and cognitive functioning. Effective management of emotional reactivity involves:

There are also a variety of questionnaires that assess anger, anxiety, depression, shame and other emotional experiences. These are relatively easy to administer and score and do not require a lot of time, but in some instances, their use may require a referral to a qualified mental health professional. In addition, if emotional reactivity appears to be an issue that interferes with rehabilitation in a major way, a referral to a mental health provider may be helpful to determine the best course of treatment.