Tinnitus Hyperacusis Mental Health App Accessibility for Hearing Loss and Deaf Community

Scientists want to study mobile mental health apps to see what features would be the most benefit when developing apps for people distressed by tinnitus and hyperacusis. Which includes people in the “normal” hearing, hearing loss and Deaf community. It’s good news. Except it takes at least 1 to 2 years for research to get published. That’s a long time to wait if you’re distressed. Speaking from personal experience, I’d rather get some helpful techniques and exercises from an app as soon as possible e.g. while on a wait list to see a psychologist or counselling professional. Even if the app wasn’t perfect for T-H, it would be better than nothing and the risk of sliding downhill into a barking dogs breakdown or another round of major anxiety and major depressive disorder.

I’ve never tried a mobile app for my mental health before, so I thought I’d check some out. I was curious if the apps were helpful and accessible. Shouldn’t people in the hearing loss and Deaf community be able to access mobile mental health apps the same as everyone else?

Jan the Guinea Pig = mild hearing loss in quiet, moderate in noise; tinnitus since 1986; hyperacusis since birth; terrible insomnia, severe anxiety and panic disorder; major depressive disorder; fibromyalgia, neurological issues and so on. I’ve taken an 8 week CBT Cognitive Behaviour Therapy course for chronic pain, a 2 day CBT for tinnitus workshop, had counselling from psychologists and psychiatrists. As an audiologist, I’ve stalked tinnitus-hyperacusis research and clinical world for over 25 years. No judgement. But I don’t like mindful meditation, it’s just not my thing. I’m also not into setting goals or putting pictures up on a hope board.

Relaxation, Anxiety and Depression App Criteria = free or free trial, iOS and Android, top ranked on multiple websites, high user ratings, reputable developers.

Accessible = can be used by normal hearing, HL and Deaf communities. Visual indicators, text based and/or spoken audio content fully closed captioned.

Partly Accessible = can be used by normal hearing and hearing loss if able to hear spoken audio content unaided or aided; audio not closed captioned.

Not Accessible = can’t be used by people who can’t hear spoken audio content. No visual indicators, text or closed captioning.

Breathe2Relax App

iOS version and Android version
Age 12+ recommended on app
Age 6+ recommended by Learning Works for Kids
Developed by National Center for Telehealth and Technology for military community to help people cope better with PTSD, anxiety and depression.

Deep or Belly Breathing Exercise = Accessible

  • proven to help with mood, relaxation, better sleep, and less anxiety, anger and unhealthy ‘fight-or-flight’ stress response.
  • visual indicator Breath Metronome.
  • closed captioned female instructions; spoken low volume with no pauses between words/phrases. Short spoken conclusion wasn’t captioned. It wasn’t anything important…but shouldn’t Deaf people and people with HL get the same info access as everybody else?

Relaxation Sounds

  • Not the greatest versions of nature, coloured noise and other sound types.

I didn’t realize my breathing was very shallow until I tried this app. It was a good reminder to practice deep breathing daily even if only for a minute or 2. Once you know the technique, you don’t need to use the app while belly breathing. I’m doing a bit of deep breathing every night before sleep. Would also be handy during panic attacks or when feeling anxious. I couldn’t understand the instructions with the relaxation sound playing at the same time.

If you've tried it, would you recommend Breathe2Relax app to other people with T-H?

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Pacifica app

iOS and Android
Free trial for 7 day Guided Plan; everything kept working after 7 days
Age 12+
Developed by psychologists for stress, anxiety and depression.

Deep Breathing Meditation = Accessible (visual indicator)

Relax Your Muscles Meditation = Partly or Not Accessible; not closed captioned. Female instructions spoken slow, low volume, with no pauses between words/phrases. Not closed captioned. This is a PMR or Progressive Muscle Relaxation technique commonly recommended to help people have less tension, anxiety, and depression, and help with better sleep.

All Other Mindful Meditations = Partly or Not Accessible; not closed captioned. There’s no reason not to close caption these. People can meditate with eyes open while reading instructions.

Health – Mood Tracker = Accessible. Text based; no audio. Your History tracks mood versus health (daily time spent on sleep, exercise and hobbies). Experts say mood tracking can be useful for people with anxiety or depression.

Thoughts = Accessible. Text based; no audio. CBT style mental exercises to help thought patterns be less negative.

CBT Based Guided Paths = Partly or Not Accessible; not closed captioned. 7 education lessons on CBT and how to use it.

Hope & Goals = Accessible.

Relaxation Sounds = Not the greatest versions of nature, coloured noise and other sound types.

I really like Pacifica, even though I’m not using the mindful meditations. It’s still free after 3 weeks. Note I didn’t finish the 7 Guided Paths lessons because I’ve learnt it before, and I was worried the free trial would end. I started doing deep breathing and PMR every night before sleep without the app once I learned techniques. Takes less than 5 minutes. Love the Health – Mood Tracker. Really saw how sleep patterns affected my mood. I realized I slept better on nights I did the deep breathing and PMR.

I really liked the Thoughts Reframe technique. Takes less than 5 minutes. I used it to reframe my top daily anxiety, and after a few days I noticed it helped my mind stop spinning with the same worries over and over again. Helped me sleep better. Can shut down negative thoughts easier during day. Found out my thought traps are mainly Mind Reading, Fortune Telling, and Labeling & Judging. After about 2 weeks, I slept for 7 days in a row. Instead of only 1 or 2 in a row, if that. That’s amazing to me after years of bad sleep.

It’s such a shame all of Pacifica content isn’t accessible with visual indicators, text based and fully closed captioned. Maybe the developers could add that in a future update? The low female voice for spoken instructions is also a problem. I only have mild hearing loss and it was hard to understand even with the relaxation sounds turned off. I’d love to see apps have an option to use a deep male voice trained in how to speak to people with hearing loss e.g. slow, natural pauses, soothing but not soft.

If you've tried it, would you recommend Pacifica app to other people with T-H?

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I know I’ve only looked at 2 apps so far. But both have accessibility problems for people who can’t hear. I hope the T-H experts take all this and more into consideration when mobile mental health apps for people with tinnitus or hyperacusis get developed. Members of the hearing loss and Deaf community need to be consulted so these apps are fully accessible. We are highest risk for hyperacusis and tinnitus distress aka stress, anxiety, depression and poor sleep. The rate of distressing tinnitus for Deaf people is 33%. That’s much higher than everyone else with distressing tinnitus. Accessibility of mobile mental health apps for people with T-H is a must-have. Otherwise, isn’t it discrimination?

Feel free to join me in trying out these apps. More on my to-review list currently include:
MindShift app for anxiety and stress in teens, young adults and adults
Aura app 3 minute mindful meditations for anxiety and stress
What’s Up app CBT style for depression
Headspace app guided meditation for stress, anxiety and depression, sleep sound

Photo Credit Rami al Zayat at Unsplash

Jan’s Book Portfolio

Jan L. Mayes MSc writes horror fiction and non-fiction, and is an international Eric Hoffer Award winning author, blogger and audiologist specializing in ghosts, noise, tinnitus-hyperacusis, hearing health education and plotting murders. Her writing has been featured at Tinnitus Today, Communique, silencity.com and The Horror News Daily.