Christmas gifts 2004 - Defra, UKrandd.defra.gov.uk/Document.aspx?Document=NO01059_3185_FRP.doc · Web viewThat is, a sound, word, phrase, or prayer repeated silently or aloud,

Coping Strategies for Low frequency Noise

Prepared for Defra by

Dr Geoff Leventhall*

Dr Steve Benton**

Donald Robertson***

June 2005Contract NANR 125

* Noise and Vibration Consultant, Ashtead, Surrey. [email protected]** Principal lecturer in Psychology, Westminster University, London. [email protected]*** Psychotherapist, 10 Harley Street, London. [email protected]

NANR125 Leventhall Draft 8 1

Coping Strategies For Low Frequency Noise Summary

A small group of people, whose complaints of low frequency noise had not been resolved, were invited to attend a series of relaxation sessions led by a psychotherapist. The aims of the sessions were to improve the participants' coping strategies and their quality of life, in order to relieve them of some of the distress which the noise caused.

Prior to the session the group was given a number of tests including:

Completion of a Low Frequency Noise Reaction Questionnaire A "quality of coping" questionnaire A "quality of life" questionnaire.

Additionally, the galvanic skin resistance and heart rate were measured under different. noise exposure conditions.

Questionnaires and tests were repeated at the end of the series of sessions in order to reveal any changes which might have occurred.

A general reduction in the subjects' stress levels was shown, demonstrating the positive effects of relaxation therapy in some cases of annoyance from unsolvable noise problems. This could lead to improved health and effectiveness and fewer demands on local services.

This report also gives summaries of the:

Perception low frequency noise Psychological effects of low frequency noise Relaxation techniques used.


1.0 INTRODUCTION............................................................................................................6

1.1 Preamble......................................................................................................................6

1.2 Human response..........................................................................................................7

2.0 LOW FREQUENCY NOISE AND ITS EFFECTS...........................................................8

2.1 Low frequency noise and hearing.............................................................................8

2.2 The development of a low frequency noise problem..............................................10

3.0 PSYCHOLOGICAL EFFECTS OF LFN......................................................................12

3.1 General Comments....................................................................................................12

3.2 The Cost of Coping with Noise.................................................................................13

3.3 Habituation: neural basis for coping........................................................................14

3.4 Sensitisation: neural awareness..............................................................................14

3.5 Effects of Low Frequency Noise: An Amalgam.......................................................18

3.6 Cognition and Annoyance........................................................................................19

3.7 LFN: The Character of Annoyance: Special Coping demands?............................19

3.8 Subjective Impact......................................................................................................22

3.9 Sleep Disturbance......................................................................................................23

4.0 LOW FREQUENCY NOISE RELATED STRESS (LFNRS).........................................24

4.1 Introduction................................................................................................................24

4.2 Tinnitus.......................................................................................................................24

4.3 Hyperacusis................................................................................................................24

4.4 Clinical Research.......................................................................................................25

4.5 Conclusions................................................................................................................28

5.0 SUBJECT SELECTION...............................................................................................29

6.0 INITIAL EVALUATION...............................................................................................31

6.1 Low frequency noise reaction questionnaire (LFNRQ)..........................................31

6.2 Analysis of the results ..............................................................................................32


6.3 Comparison with the Tinnitus Reaction Questionnaire..........................................36

6.4 Psychological tests....................................................................................................36

6.5 Quality of Life: Current..............................................................................................37

6.6 Quality of Coping Questionnaire:.............................................................................40

6.7 Quality of Life: Before and After Noise Comparison.............................................42

6.8 Personality Questionnaire: Insights Discovery Evaluator.....................................44

6.9 Physiological Parameters: Results...........................................................................46

7.0 THE RELAXATION SESSIONS...................................................................................48

7.1 Introduction................................................................................................................48

7.2 Rationale for Treatment Plan....................................................................................48

7.3 Group Structure and Attendance..............................................................................49

7.4 The Benson Relaxation Response............................................................................50

7.5 Principles of Relaxation Therapy..............................................................................52

7.6 Group Dynamic & Characteristics...........................................................................54

7.7 Anxiety and Depression...........................................................................................56

7.8 Group Feedback & Evaluation..................................................................................57

7.9 Conclusions...............................................................................................................59

8.0 FOLLOW-UP TESTS...................................................................................................59

8.1 Low Frequency Noise Reaction Questionnaire Repeat.........................................59

8.2 Post Therapy Ratings: Quality of Life Questionnaire (Q of L)...............................61

8.3 Post Therapy Ratings: Coping Questionnaire........................................................63

8.4 Quality of Life and Coping comparisons before and after relaxation therapy.....66

8.5 Physiological parameters after relaxation therapy................................................68

9.0 COMMENTS FROM SUBJECTS................................................................................69

9.1 Comments returned with the Low frequency Noise Reaction Questionnaire......69

9.2 Comments returned on the Participants' Evaluation Form...................................73

10 CONCLUSIONS............................................................................................................76


APPENDIX 1 LFN REACTION QUESTIONNAIRE..........................................................77

APPENDIX 2 QUALITY OF LIFE WITH NOISE. FULL RESULTS.................................81

APPENDIX 3 QUALITY OF COPING QUESTIONNAIRE: CURRENT WITH NOISE:....87

APPENDIX 4 QUALITY OF LIFE QUESTIONNAIRE BEFORE LF NOISE......................89

APPENDIX 5 QUALITY OF LIFE AFTER RELAXATION THERAPY.............................95

APPENDIX 6 QUALITY OF COPING (AFTER RELAXATION THERAPY)..................101

APPENDIX 7 THE JUNGIAN MODEL FOR INDIVIDUAL DIFFERENCES...................103

References.......................................................................................................................104


Coping Strategies for Low Frequency Noise

1.0 Introduction 1.1 Preamble.Low frequency noise, which in this study covers the frequency range from about 10Hz to

200Hz, (Leventhall et al., 2003), presents particular problems to those people who are

sensitive to its effects, such that a separate category of "low frequency noise sufferers"

has been recognised, although a "low frequency noise syndrome" has not yet been

defined. The publicity which infrasound and low frequency noise have received over the

past 35 years has led to it occupy a special place in the communal mind and a result of the

publicity may be that descriptions by sufferers of their perception of the noise, and its

effects on them, have been conditioned by external influences. However, this must not

detract from the fact that there are a number of low frequency noise sufferers in the

community who urgently, and rightly, plead for a solution to their problem.

The number is not known, but a review in 1989 suggested that local authorities in the UK

might receive over 500 complaints of low frequency noise a year for which nearly 90% of

the complaint noises were identified (Tempest, 1989). Recent work (Moorhouse et al.,

2004) on a small sample of complaints, indicates that only about a third of complaints are

resolved by technical means, whist the sources of the remainder cannot be found, the

noise cannot be measured, or measurements of noise do not correlate with the

complainant's perception of it.

Thus, a group of long term complainants develops, either surviving on their own or turning

inward for mutual help, which has been given in the UK by the Low Frequency Noise

Sufferers Association. There is also an international Yahoo Group Hum Forum, which is

"…. devoted to discussion of the "Hum", a worldwide phenomenon. The "Hum" is a

mysterious noise heard by 1 to 10 percent of the population in certain areas, including

North America, Europe, Great Britain, and Australia. The classic hum sound is comparable

to the sound of a distant diesel engine idling. There have been extensive reports of the

Hum in the United Kingdom since at least the early 1970s. The two best-publicized areas


in the United States that have been plagued by the Hum are Taos, New Mexico, and

Kokomo, Indiana."

Low frequency noise, as perceived through the Hum, is a world wide phenomenon of

unknown origin. Members of the Yahoo Hum Forum have suggested that their problem is

due to unusual sensitivity to electromagnetic waves, although there is no evidence for an

auditory sensation at the low field strengths to which the public is exposed. High peak

levels of electromagnetic waves are required to give a false perception of noise, which is

typically perceived as buzzing or clicking, not like the classic hum description of a distant

diesel engine. (Elder and Chou, 2003).

1.2 Human response. We are involved here in the complicated area of human response to noise, which shows

considerable individual differences. When people

are exposed to an unwanted noise they typically

adopt a position on a response scale somewhere

between "Quiet Acceptance" and "Aggressive

Resentment", as shown in Fig 1.1. The point at

which they place themselves on the scale depends

partly on the characteristics of the noise and also

on other factors, including situational and

personality features of the person concerned.

The problem increases in complexity as the noise

level becomes lower and the responses reduce in

number and severity. It is believed that there are a

group of noise sensitives, who will always

complain about noise, especially a new source,

just as there are a group of noise insensitives, who will rarely complain.

A model for human response to noise identifies three stages, detection, perception and

response. (Leventhall, 1998)

1. The input stimuli enter the detection mechanism, the ear.

2. The stimuli are perceived in the brain as noise, giving an indication of their

frequencies and levels.

3. Response, which is greatly influenced by emotions, follows from perception.


Aggressive resentment

Vocal non-acceptance

Aggrieved Acceptance

Reluctant Acceptance

Passive Acceptance

Fig 1.1 Response scale

There is variability at all the stages, but the best quantified steps are detection and

perception, leading to the well known hearing contours and hearing thresholds. It is the

response which displays the widest variations where, for a given low level of noise,

response may vary between “not bothered” to “it’s ruining my life” and a position adopted

accordingly on the response scale shown in Fig 1.1.

We have responsibilities to a group of people, genuinely suffering from noises whose

sources have not yet been located. Tracing and controlling noise sources must always be

the highest priority, but it is proper to consider some interim means of relieving the

problems of complainants. This report describes a therapeutic approach to ease the

stress which has been produced by unsolved problems of low frequency noise, so

improving the coping capacity of those affected and helping them to move lower down the

response scale of Fig. 1.1.

2.0 Low Frequency Noise and its Effects

2.1 Low frequency noise and hearingThe perception of low frequency noise differs from that of higher frequencies for the


0

20

40

60

80

100

120

0 20 40 60 80 100 120 140 160 180 200Frequency Hz

Soun

d pr

essu

re le

vel d

B ISO226:2003

Watanabe and Moller 1990

Fig 2.1 Low frequency threshold

following reasons.

The levels required for perception are higher

The growth of loudness with change of level is more rapid.

The average perception threshold is shown in Fig 2.1, which contains two overlapping

studies. The threshold above 20Hz is from ISO226 (ISO:226, 2003), whilst that from 4Hz

to 125Hz is from Danish work (Watanabe and Møller, 1990b).

The threshold varies from 107dB at 4Hz to 14dB at 200Hz and is 97dB at 10Hz.

There is a more rapid growth in annoyance as the level increases at low frequencies,

shown in Fig 2.1.(Møller, 1987) At the lowest frequencies, which are on the right of the

figure, the level must be greater for the sound to be perceived, but the annoyance range at

4Hz is covered in about 10dB, compared with 40dB at 31.5Hz.


Fig 2.2. Annoyance rating, showing rapid growth at low frequencies

The thresholds values shown in Fig 2.1 are

median values, for which 50% of the test

subjects (who were typically young adults) are

less sensitive and 50% more sensitive. The

standard deviations of threshold measurements

are about 6dB, which leads to 16% of the

population least 6dB more sensitive than the

median and about 2% at least 12dB more

sensitive than the median. Thus, one must be

aware of the possibility of the occasional listener

with very sensitive hearing. The thresholds of

Fig 2.1 are for young adults and although

hearing deteriorates with age, the main effect is

at higher frequencies. A Netherlands study (N S

G, 1999; Sloven, 2001; van den Berg and

Passchier-Vermeer, 1999) defines the threshold

for the 10% most sensitive 50 – 60 year olds as

a criterion for noise assessment. These

thresholds are about 3dB higher than those of ISO226 as in Table 1, but ISO 7029

(ISO7029, 2000), which deals with the statistics of the threshold in the frequency range

from 8000Hz down to 125Hz, shows that, at 125Hz, 10% of 60 year old males have at

least 4dB greater hearing sensitivity than the median young adult , shown in Table 2.1.

There is clearly sufficient variation in hearing thresholds to require caution in using the

median threshold to assess a noise problem.

2.2 The development of a low frequency noise problem. A typical low frequency noise problem has sudden onset, or sudden realisation that the

noise, which may build up over time, is present. Only one person in a family may be able

to hear the noise, which is normally most prominent at night. At the start of the problem,

hearers may assume that the noise is produced within their home and turn off all services,

but with no result. Suspicions then turn to their neighbours or to a local industry, perhaps

leading to night time searches around the locality.


Low frequency hearing threshold for levels for 50% and 10% of the population. (NSG reference curve in bold)

Otologically Otologically Unselected Selected Population Young adults 50 –60 years (ISO 226)

Freq Hz

50%dB

10% dB

50%dB

10% dB

10 103 92 96 89 12.5 99 88 92 85 16 95 84 88 81 20 85 74 78 71 25 75 64 66 59 31.5 66 55 59 52 40 58 46 51 43 50 51 39 44 36 63 45 33 38 30 80 39 27 32 24100 34 22 27 19125 29 18 22 15160 25 14 18 11 200 22 10 15 7

Table 2.1. NSG reference curve

The process shown in Fig 2.3 might ensue. Following perception, the complainant

searches their home. If a source is found the problem can be solved. If a source Is not

found the search extends to outside the home. Again, if a source is found a solution is

possible. If a source is not found, suspicions may fall upon a neighbour and, if the

complainant becomes convinced that the neighbour is harbouring the source of the

problems, a very tense situation may develop as the complainant moves further up the

response scale of Fig.1.1.


NO NO

Control source Treat

Search house

Source found

Search outside

Source found

Seek help

EHO GP

Medical problem

Perception

NO

NO

Locate source

Fig.2.3 The progress of a low frequency noise problem

Help may be sought from either the Environmental Health Department, which will carry

out noise investigations, or from the GP who will look for a medical problem. If either of

these finds a lasting solution, the problem is over, but failure by one may lead to transfer

to the other in a cycle of increasing frustration and distress.

EHO's may have difficulties in solving persistent low frequency noise problems, as their

experience is largely with A-weighted noise nuisance measurements, which excludes

much of the low level low frequency noise annoyance at the basis of the problems which

are considered in this Report . Additionally, many low frequency noise problems,

including those which can be detected by the EHO, do not classify as statutory nuisances.

Complainants receive some relief when away from their homes, but continue to live in a

condition of persistent distress. The psychological basis of this distress is considered in

the next section.

3.0 Psychological Effects of LFN 3.1 General Comments.

For those individuals trapped within the experience of living with a low frequency noise

(LFN) and the consequent impact upon their well-being and quality of health, the failure by

environmental professionals to identify and locate the source are further irritants rather

than leading to closure. Issues surrounding the application of inappropriate assessment

procedures and the particular problems associated with low frequency source location

form a significant context within which an individual's experience is shaped. The issues

are wide ranging and frequently interactive. Perhaps the noise can be identified, yet the A-

weighted level is too low for action; maybe the individual complainant is the only person in

the area that is concerned by the noise. Often it is reported that they are the only

members in the household suffering from the noise. Sometimes no one else can hear it,

and no measurement can detect it. Complainants may be found to have tinnitus, which is

taken as an end to the acoustic problem. It is likely that the category of LFN sufferer

contains a mixture of aetiologies and the most likely will be tinnitus with or without a LFN

source. It is also the case that, from this category of sufferer, will emerge a

disproportionate number of long term noise complaints and a familiar cluster of symptoms

(Møller and Lydolf, 2002) that include; sleep interference/insomnia, headaches, poor

concentration and mood swings.


The issue of whether or not a verifiable source can be identified as that which is

responsible for a complainant’s experience of noise is one that continues to focus

interventions upon causality rather than symptoms. For particular sub-categories of LFN

complaints there seems to be benefit in moving towards a blended approach to

assessment and intervention. One that balances the potential short-fall in existing

assessment protocols with the psychological distress commonly reported by sufferers and

a need to support recovery and improved quality of life.

3.2 The Cost of Coping with Noise

What is clear is that, on a case-by-case basis, the ‘full impact’ of individuals’ experience of

living with noise has increasingly been argued to qualify as a chronic stressor (Evans et

al., 2000) The cost of coping can be evidenced in learning decrements, physiological

deterioration and reduced quality of life. Coping is a learnt response, we learn how to cope

with stressors and any unwanted event or stimulus which is a potential stressor. In our

environment these potential stressors range from loud aircraft noise to muffled bass from

the neighbours.

In a study of school children, (Evans G W et al., 1998) it was reported that children, when

subjected to loud noise from a nearby airport, taught themselves to tune out sounds so

they could concentrate. However, this led to them also screening out ‘wanted’ aspects of

speech. An indicator of the cost of their coping was found in their lower reading scores.

The children were tuning out opportunities to learn the subtleties of language. Similarly,

people who live in extremely crowded unwanted conditions learn to cope through creating

a secure internal space, tuning out others as unwanted, tending to withdraw from social

exchanges.

Longitudinal studies examining the effects of airport noise on reading, memory, attention

and speech perception in children are cited as further evidence that exposure to chronic

noise can have serious health, learning and motivational effects in children and adults

(Hygge et al., 2002).

Many types of stimuli impact upon us through each moment of our daily lives and, in

theory, each one can represent a potential stressor, a stimulus that needs responding to

and coping with. Such a vast array of stimuli exists that, unless there was some semi-


automatic and physiologically inexpensive way to process it, we would find ourselves

awash with unwanted stimuli, out of coping space and cognitively and emotionally

exhausted in a short time.

High impact/intensity stimuli induce particular coping strategies: we can identify and

usually escape from, avoid or physically remove them. However, many environmental

demands originate from stimuli of a less prominent nature, which require a different form of

coping. Habituation offers an effective ‘low maintenance’ level of processing and coping for

these stimuli.

3.3 Habituation: neural basis for coping. Habituation leads to a decrease in intensity of response to a stimulus as a function of

ongoing or repeated presentation of that stimulus. It is most often observed for relatively

mild stimuli and is the foundation for the process that allows us to learn to ignore

inconsequential or redundant stimuli that apparently represent no serious consequences

e.g. learning to tune out the ticking of a clock. Individuals learn to pay less attention to

redundant stimuli, whilst retaining a processing and coping capacity able to augment this

response if conditions change: a simple form of non associative learning, yet a central one

to the maintenance of a stable perceptual experience (Kandel, 1979). Without this coping

mechanism individuals would be prone to treating all stimuli as equally threatening.

Many LFN sufferers characterise their experience in terms that are consistent with a break

down of this coping capacity, where a low level stimulus induces an increasingly negative

subjective and cognitive effect. There is often reported a series of behavioural and

emotional aspects, which may be illustrative of another and related non-associative form of

learning, that is, sensitisation.

3.4 Sensitisation: neural awareness. This process describes the manner in which an initial level of weak reaction to a stimulus

intensifies if the original stimulus is followed by a painful or stressful one. Both these

processes are said to provide the fundamental neural building blocks for our ability to

encode our experience of the environment in ways that support our capacity to cope. LFN

sufferers report that the noise seems to dominate the acoustic environment, even at low

sound pressure levels and that they could not tune the noise out. Nor does it diminish with


repeated exposures, in fact, commonly the experience is the opposite in that an unwanted

"tuning in" seems to become easier.

Closely allied to these processes are those described as the building blocks of associative

learning; operant and classical conditioning. These forms of learning are mentioned here

as they are argued to perform similar functions, at the cognitive and behavioural level, as

those achieved by habituation and sensitisation at the neural level. The experience of

sufferers is frequently described as a decline in a sense of control combined with a

significant increase in anxiety (Guest, 2002), (Nagai et al., 1989). The manner of anxiety

onset is indicative of an acquired response, a learned association with a stimulus that

acquires ‘associations’ of strong negative effect. In terms of the classical conditioning

paradigm, the same power of a biologically significant stimulus (e.g. loud noise, cold) can

be acquired through repeated pairings (trials) with a previously neutral stimulus (e.g. non

startle low level noise). Repeated experience of an ‘unwanted and uncontrollable’ noise

could lead to the association of increased annoyance, with failing habituation, over time. It

has been reported that LFN does seem to pose particular difficulties for the habituation

process (Benton, 1997a) (Broner, 2004), (Pawlaczyk-Luzszynska et al., 2004) . If an

individual’s ability to process out unwanted stimuli is reduced, then the subjective impact of

non-biologically threatening stimuli may undermine their stability of mood and erode their

sense of well being. A characteristic aspect of LFN effects is the incremental, yet steady,

undermining of the individual's sense of well being, associated with elevated anxiety levels

and stress symptoms (Persson and Rylander, 1988; Persson-Waye and Rylander, 2001).

The widespread and non prominent, background nature of LFN has long been recognised

as in the Report of the Noise Review Working Party (DoE, 1990). Commenting on low

frequency noise. It said

“Low frequency noise does not give rise to the same level of concern as neighbourhood noise but it can have a serious effect on the quality of life of those affected by it”.

The impact of LFN upon quality of life and mood continues to create research interest as

the measurement of the relationship between mood, immunologic health and well-being

become more amenable to non invasive measurement techniques. (Persson-Waye et al.,

2003), (Clow, 2004) . Moreover, the type of subjective disturbance associated with many

LFN complaints is indicative of chronic rather than acute behavioural responses. On-going

research into the interaction between mood-state and well-being has suggested the

complex relationship between the level of well-being and stress related onset, whilst


severity of physical deterioration has highlighted the interactive nature of mood, well-being

and health (Evans et al., 2000).

Sound has no intrinsic impact value outside of the context within which it is experienced

and this experience is a construction, one that is directly related to an individual's cognitive

and physiological capacity to cope (Eysenck et al., 1980) . Noise is only one of the many

stressors people have to cope with in their everyday lives. For example, in a study of the

interactive effects of noise stress, personal project stress and subjective health,

questionnaires were administered to adult inhabitants living in noisy and not-noisy

residential environments (Marjut-Wallenius, 2004). The respondents (n=147) filled in the

revised version of Little’s Personal Project Inventory, the Eysenck Personality Inventory

(EPI) scale of neuroticism, and the Somatic Symptom Checklist, which rated their general

health status. Subjects also answered questions concerning noise annoyance and

disturbance to daily activities. The results revealed an interactive effect between noise

stress and personal project stress. Measures were made on self-rated general health and

somatic symptoms questionnaires and results were taken as indicators of the cost of

adaptive coping to multiple stressors. Annoyance, due to noise inside the house as well as

disturbance to daily activities, was shown to interact with personal project stress.

The relations between the variables were found to be independent of scores on the

neuroticism scale. Noise annoyance and disturbed daily activities were related to poorer

general health and more numerous somatic symptoms when interacting with higher levels

of personal project stress.

The role of personality and individual differences in individual’s repsonse to noise has led

to some contradictory and confusing results. The review of this issue conducted by

Belojevic (Belojevic et al., 2003) covered a twelve year period of research into the role of

neuroticism, extraversion and general noise sensitivity during task performance under

conditions of noise. The relevant model of individual differences indicated that Neurotic

persons might show enhanced “arousability” i.e. their arousal level increases more in

stress. Additional unfavorable factors for neurotics are ‘worry’ and ‘anxiety’, which might

prevent them coping successfully with noise, or some other stressors during mental

performance.


In numerous experiments, introverts have shown higher sensitivity to noise than extroverts

during mental-loading performance, while extraverts often cope with a boring task by

requesting short periods of noise during performance! The analysis of correlation results

regularly revealed a highly significant negative relationship between extraversion and

noise annoyance during task performance. Many studies of performance in noisy

conditions were found to show that individuals with higher ‘self rated’ scores for noise

sensitivity may be inhibited from achieving the same work results as those scored as less

sensitive to noise. This inhibition may also lead to psychosomatic, neurotic or other

difficulties. Belojevic et al (2003) suggest that those scoring higher on the ‘stable’

personality dimension, with extravert tendencies and with a relatively lower subjective

noise sensitivity may be expected to cope better with noise during mental performance,

compared to people that scored higher on the introvert personality dimension.

An analysis of personality and noise annoyance explored the usefulness of the

Enneagram, which recognises three personality types who work from the Gut, the Heart

and the Head respectively (Bryan, 2002). Earlier results of a laboratory study (Moreira

and Bryan, 1972) using tape recordings of 1) aircraft noise, 2) traffic noise and 3) industrial

noise, had found significant and stable differences in annoyance for a group of 34 normal

hearing subjects. The correlations between a range of personal factors and annoyance

failed to produce significant relationships. However, annoyance was correlated with some

measures of personality given by the Rorschach Projection Test. The results indicated a

relationship between noise sensitive personalities and higher levels of Empathy.

The common element from much of the research conducted into these psycho-

physiological parameters confirms the central role of the ‘unwantedness’ of the noise. This

attribute has an established role in the growth of stress and confirms the essential role

played by psychosocial factors in interacting with other factors (including personality) in

shaping how well individuals are able to deal with competing demands. (Kalveram, 2000)

points out that much psycho acoustical noise research has limitations, because it is based

upon the correlation between annoyance ratings and physical measurements of sound

energy, with a subsequent correlation of annoyance and sound level. Kalveram proposes

an “ecological” approach to noise research, which emphasises the psychological functions

of sounds. Annoyance originates from acoustical signals which are not compatible with, or

which disturb, these psychological functions. Kalveram has extended his approach to

include “psycho-biological” effects. Within this model annoyance conveys a “possible loss

of biological and behavioural fitness". Such a loss of fitness would result from an


imbalance between the psychological and bio/physiological mechanisms of coping,

evidenced by the break down in cognitive selectivity and habituation (Callan and

Hennessey, 1989).

The formation of effective behavioural coping strategies is an integral part of the

adaptability of these processes, as they act to match resource with demand (Lazarus and

Folkman, 1984). Effective balance between capacity and demand may prompt

experiences that correspond to effective habituation while an imbalance may correspond

to sensitisation.

The common theme across studies assessing the subjective impact of LFN has been the

tendency for subjects'/sufferers' annoyance to increase and the quality of lives to degrade,

over time. Developing effective personal coping strategies for individuals may offer a

targeted solution to many suffers. In order to achieve this, a detailed examination of their

‘experience’ is a prerequisite.

3.5 Effects of Low Frequency Noise: An Amalgam. When assessing the problem of environmental LFN, individuals' symptomatology may

represent a start point of at least equal value to that of the standard acoustic protocol

routinely employed for noise annoyance cases (Leventhall et al., 2003). This is especially

the case given that many sufferers’ appraisal of ‘their noise’ experience will be shaped by

a multitude of factors, mentioned above, which will include the perceived quality and

effectiveness of assessment as practiced by the relevant professionals (e.g.

Environmental Health Officer).

It has been suggested (Benton and Yehuda-Abramson, 2002) that consequent upon the

drive to maintain a standardised approach to general noise assessment, anomalies of

assessment have emerged within the area of LFN. It is likely that inappropriate

measurements may be taken and anomalous interpretations made. One key result of this

procedural mismatch is the noted deterioration of communication between the EHO and

the noise sufferer, a deterioration that frequently characterises LFN complaints (Guest,

2002), a situation likely to undermine the sufferer's capacity to establish personal and

shared coping strategies. This may accord with sufferers frequently reported sense of

isolation and abandonment.


3.6 Cognition and Annoyance. Individual response to noise is a complex response, as is annoyance. Like any other

stimulus, noise is one of many competing demands impinging upon individual awareness

at any given moment. However we are equipped with a number of powerful ‘tools’ which

enable us to cope with an impressive range of information processing, in serial and parallel

style. These tools are as powerful as they are flexible. They must be able to retain

perceptual stability while processing information from diverse stimuli and information

coded and decoded from the sensory to the semantic. The capacity to take into account

diverse inputs, that form active components of any appraisal, means that appraisals are

responsive to changing priorities. One consequence of this fundamental characteristic is

that the same type and level of noise under one condition may be extremely annoying and

unwanted, while under other conditions it may be perceived or experienced as pleasant

and wanted.

There appears to be growing consensus that the cognitive signature of a noise can be as

important as that of the acoustic signature. (Grime, 2000)

The straightforward prediction of annoyance from loudness has proved difficult, apart from

well-defined categories of noise and conditions, as any linear relationship is usually

situation and task specific. This feature has proved of interest to LFN researchers as many

LFN sufferers experience distress at noise levels close to or just above their hearing

threshold for the noise.(Moorhouse et al., 2004)

The question of how to develop the best single index or weighting network as a reliable

predictor of noise annoyance has, in the light of successive experimental findings, tended

to be refocused towards how best to represent the differential nature of noise character

and impact as indicated by the development of composite weighting and correction values

for annoyance curves and guidelines (Poulsen and Mortensen, 2002). Annoyance viewed

as the product of failed coping offers an approach to understanding LFN effects that is

able to accommodate personal factors, noise character and variable cognitive loading as

part of a coherent framework.

3.7 LFN: The Character of Annoyance: Special Coping demands?The development of one standardised approach to noise and annoyance measurement,

assessment and impact rating raises particularly difficult issues (Grime, 2000) as the role

of individual differences remains central, and is there to highlight the significance of


measurements ‘ecological validity’ (Hoc, 2001) and individuals' capacity to impose coping

through appraisal.

While the role of individual differences in hearing and annoyance sensitivity has been

widely researched, the results have led to limited application to noise assessment criteria,

with some adjustments made to accommodate specific acoustic features, such as pulse

and tonal quality. Individual differences in sensitivity to noise in general, and LFN in

particular, have been identified and the scores on work related tasks have shown

differential responses under specific experimental conditions. For example when 32

subjects were exposed to moderate levels of low frequency noise during mentally

demanding tasks. (Persson-Waye et al., 2002) The work demands weighted the coping

processes in order to observe LFN effects in terms of stress and annoyance, and the

influence on the secretion of cortisol. Subjects were exposed for a period of two hours to

ventilation noise, with dominant low frequencies (low frequency noise) or a flat frequency

spectrum (reference noise), both at 40dBA level . Subjects were categorized as high- or

low-sensitive to noise in general, and low frequency noise in particular, based upon scores

from self-report questionnaires. Results showed that cortisol concentrations during the

task are not significantly modulated by the noises, or related to noise sensitivity alone. The

normal circadian decline in cortisol concentration was, however, significantly reduced in

subjects rated as ‘high-sensitive to noise’ in general, when they were exposed to the low

frequency noise. This noise was rated as more annoying and more disruptive to working

capacity than the reference noise

It has also been suggested that ‘character’ of LF noise poses particular difficulties to

individuals’ capacity to habituate (Benton, 1997a) (Benton, 1997b)

Recent work investigated the properties of LFN character (Pawlaczyk-Luzszynska et al.,

2004). The experiments showed that LFN, defined as broadband noise with dominant

content of low frequencies (10-250 Hz), differed in its perceived nature and impact from

other noises at comparable levels. The study assessed the influence of LFN on human

mental performance. Subjects were 193 male paid volunteers. They performed

standardized tests: the Signal Detection Test (test I), the Stroop Colour-Word Test (test II),

and two sub-tests of the General Aptitude Test Battery, i.e. the Math Reasoning Test (test

III) and the Comparing of Names Test (test IV). The experimental design employed three

different acoustic conditions. These conditions were; background laboratory noise of about

30 dB(A), LFN and a broadband noise at comparable dB(A) levels of 50 dB. Subjects were


assigned randomly to the varied experimental conditions. After the test session, the

subjects completed a questionnaire aimed at rating the subjective annoyance of exposure

conditions during the tasks, and assessing individual sensitivity to noise in general and

LFN in particular.

The main effects of exposure and/or noise sensitivity on the tests results or their

interactions were found in three of the four tests performed (tests I, II and IV). The

tendency toward weaker results in low frequency noise compared to other conditions was

observed in persons classified in test II as more sensitive to LFN (higher value of reading

interference). The significant effect of both exposure and sensitivity to noise on annoyance

rating during test performance was also noted. The annoyance of LFN and the reference

noise was rated higher than that of background noise. LFN at 50 dB(A) could be perceived

as annoying and adversely affecting mental performance (concentration and visual

perception), particularly in persons sensitive to LFN and particularly in those persons self-

rated as sensitive to LFN.

As the subjective ‘loudness’ of the noise had been matched, the authors argued that the

‘character’ of the noise carried a form of added value in terms of its capacity to annoy, in a

manner that would not have been predicted by the single measure of sound pressure

values.

Corresponding evidence of the complex nature of annoyance was found in a pilot study

reported by Broner (Broner, 2004). This paper describes how annoyance effects for LFN

noise ‘character’ behaved in a manner contrary to that predicted by loudness values.

Subjects listened to stimuli with prominent low frequency spectral peaks for an hour.

Loudness and annoyance ratings were elicited using a method of Magnitude Estimation.

The findings showed that, at lower frequencies, individuals rate of habituation to loudness

was more rapid than that for Annoyance. Broner argued that the basic assumption upon

which many noise assessment metrics are founded is flawed and that a non linear

relationship can exist between annoyance and loudness. In this instance, as frequency

decreased to below 50Hz, the relationship was indeed inverse.

These studies appear to offer a degree of support to Benton and Leventhall’s findings

based upon an investigation into the impact of noise character upon performance and


associated subjective states (Benton and Leventhall, 1986). The experiment compared the

impact of pure tones centred at 40 Hz and 100 Hz (both modulated at 1 Hz) and a narrow

band noise centred at 70 Hz, all at a level of 25 dB above the individual hearing threshold,

and recorded traffic noise (90 dB Lin) and a silent control condition. They found that the

tones centred at 40 Hz and 100 Hz caused more errors in a dual task situation, i.e. when

the subjects performed two tasks in parallel, compared with the scores during traffic noise

and silence. The effects were especially pronounced during the last ten minutes of the

total 30-minute exposure. Further support for specific interference performance impairment

caused by low frequency noise is given by Benton and Robinson (Benton and Robinson,

1993), where it was found that under conditions of narrow band low frequency noise at 70

dBC or 95 dBC, subjects made more semantic and spelling errors on a proof reading task.

The subjects also rated the low frequency noise as more annoying than two other noise

conditions (speech and white noise, 20-20k Hz) matched for loudness against the narrow

band low frequency noise.

A lower learning rate was found in a demanding verbal grammatical reasoning task when

the task was performed during exposure to simulated ventilation broadband noise (15-

1000 Hz, 51 dBA, 57 dBD) with a dominance of energy in the low frequency area

(Kjellberg and Wide, 1988). The comparison was made between two groups working with

the task for 25 minutes. In the first group, the noise was turned on after five minutes and,

in the second group, the noise was turned on after 20 minutes.

Similar results were reported by Persson Waye (Persson-Waye et al., 1997). During

exposure to a low frequency ventilation noise (A-weighted sound pressure level 42 dB),

subjects tended to need longer to respond to the task as compared to working when

exposed to a ventilation noise of equal A-weighted sound pressure level, but not

dominated by low frequencies.

3.8 Subjective Impact. It appears that, for a proportion of people, exposure to environmental LFN brings about an

amplification of impact as a result of intensifying the interactivity of factors that underpin

general responses to noise. Addressing individuals’ experience of the noise is pivotal, as

LFN appears to operate at the margins of processes that underpin coping.


The importance of low frequency noise was pointed out in a report on community noise

prepared for the WHO that recognised the individual nature of LFN as an environmental

pollutant (Berglund et al., 2000). The report called for lower values to be incorporated in

guidelines regulating community exposure to LFN. While some researchers argue that

such is the complexity of interaction between personality, individual differences and

personal and social moderating factors that questions are raised about the feasibility of a

nation-wide standardised policy (Grime, 2000). Every LFN case may well be the exception

to the rule. Accordingly, a full and rounded appraisal of LFN annoyance will need to

examine the central role of personal factors.

3.9 Sleep Disturbance. A common complaint of low frequency noise sufferers is that of sleep disturbance. Several

studies have shown that, in general, increased levels of noise were associated with sleep

disturbances. These disturbances were characterized by a number of symptoms of

interference including; shorter sleep duration, more frequent awakenings, downward shifts

in sleep stages, and increased sleep latency (i.e. difficulty in falling asleep).

Again the picture is a complex one with a number of stimulus features playing an important

role in shaping individuals’ coping response. For example (Bugliarello et al., 1976)

describe several factors that affect sleep disturbance: factors involving the stimulus itself

e.g. type of noise, repetition, duration and intensity and the stage of sleep during which the

noise occurs and individual variables (e.g. state of health and age)

The report also notes that individuals’ disturbance thresholds varied significantly, with

some people being disturbed by levels as low as 35 dBA and others being able to sleep

through 90 dBA levels.

There was also evidence that an individual’s sleep disturbance thresholds would vary in

response to the type of noise. For example, it appears that most people can sleep through

60 dB of aircraft noise, but only 40 dB of street traffic noise (Bugliarello et al., 1976)

There also seems to be a relationship between age and intensities of noise required to

wake people. The intensity needed to induce waking may be inversely related to age, with

older subjects needing less intense noises to be woken. Most low frequency noise

complainants are middle aged or elderly.


Some evidence indicates that the REM period of sleep is particularly susceptible to

intrusion. It may be the case that during the early hours of the morning, when individuals

are likely to be in the REM cycle, background noise level is at its lowest. Reduced

background masking would enhance any LFN signature, which with increasing age may

combine to disrupt sleep.

4.0 Low Frequency Noise Related Stress (LFNRS).4.1 Introduction. "The hum" is a popular name given to an intrusive low-frequency sound of external, but

usually unidentifiable origin, which has been defined as (Leventhall et al., 2003)

The Hum is the name given to a low frequency noise which is causing persistent

complaints, but often cannot be traced to a single, or any, source. (page 43)

The Hum appears to share some clinically-relevant similarities to two other hearing-related

conditions: tinnitus and hyperacusis.

4.2 Tinnitus. This is a ringing or some other sound believed to be of physical but internal origin, e.g.,

originating in the nervous system or in the internal physiology of the ear. Tinnitus can

cause annoyance, stress and related health problems. Although some tinnitus is

"pathological", meaning that a cause has been identified, the majority are "idiopathic", and

no cause can be located. Pathological tinnitus has been linked to a large and diverse

range of causes (Hogan, 1998).

There is a small amount of recent clinical research on the treatment of tinnitus. Crucially, it

tends to focus on alleviating supervening distress (tinnitus-reaction) rather than directly

removing the auditory stimulus (tinnitus-sound) itself.

4.3 Hyperacusis. This is a general over-sensitivity to objectively real, external sounds, which can also

cause annoyance, stress and related health problems. Hyperacusis sometimes

accompanies other problems, including tinnitus, but there does not appear to be significant

existing research on the clinical psychotherapeutic treatment of hyperacusis itself.


The Hum, tinnitus and hyperacusis are syndromes, the precise aetiologies of which are

often unknown, i.e., they may each have more than one cause. The Hum sometimes

appears to be co-morbid with tinnitus or hyperacusis, but essentially differs from both of

them.

The Hum differs from tinnitus in that it is believed by sufferers that the sound is of external

origin, although they may not be able to identify the source. It differs from hyperacusis in

that it appears to be a sensitivity only to a particular type of low frequency sound and not

more general sensitivity to sound.

Psychological distress found in the Hum, and in other cases of sensitivity to low frequency

noise (where the source is identifiable), will be referred to as 'low frequency noise related

stress' or, for convenience, 'LFNRS.' , by analogy with work related stress – WRS. Even

in those cases where the noise source is identifiable, the subject may nevertheless be

experiencing stress, or other health related problems, because of their psychological

reactions to the sound stimulus.

4.4 Clinical Research. No existing clinical literature specifically related to the psychotherapeutic treatment of

LFNRS or hyperacusis has been found. For that reason, the existing research on tinnitus

habituation is considered, from which it is proposed that certain clinical hypotheses can be

drawn by analogy.

Leventhall et al (2003). conclude their report on low frequency noise with the following

remarks on coping skills,

Some Hum sufferers report that they have been able to adopt strategies which ease

the effects on them of their noise of unknown origin. An element of the strategy is to

stop fighting the noise and relax one's physical and mental responses to it. There is a

great deal to be learned from the methods of tinnitus management, which have been

developed over the last 20 years. (page 78)

There appear to be obvious analogies between LFNRS and tinnitus stress. Indeed, it is

believed that some cases of undiagnosed tinnitus could be mistaken for LFNRS,


Sometimes, then, the cause of an annoying hum can be related to tinnitus, particularly

if there is a sole complainant and other close family and neighbours cannot hear the

noise – though some persistence is often necessary to get the complainant to

acknowledge the explanation. (Rice, 1994)

There are two potential goals of tinnitus treatment:

1) 'Habituation' to the sound, meaning that the sound continues, but is perceived as

provoking less stress or, ultimately, no stress at all.

2) Remission of the intrusive sound, meaning that it diminishes in volume and/or

frequency. Ultimately that it is extinguished altogether.

Most tinnitus research focuses on the former goal. As one recent study concludes,

In sum, the outcome of various treatment attempts is largely negative when the aim is

to silence the tinnitus. There is, however, evidence to suggest that psychological

treatment and proper medical management can decrease the annoyance caused by

tinnitus. (Andersson et al., 2002)

Tinnitus research, therefore, primarily demonstrates the effectiveness of treatment aiming

at habituation. The techniques used to achieve this are adapted from standard

psychotherapy interventions for treating anxiety and depression (Andersson et al., 2002).

Although the authors of the study describe their treatment strategy as cognitive-

behavioural therapy (CBT) it should be noted that the central, and seemingly most

effective, component of this treatment was relaxation therapy. In other words, recent

meta-analysis suggests that the most effective tinnitus treatment is primarily the use of

standard therapy approaches to reduce the distress caused by the sound; basically,

tinnitus treatment is best regarded as a specially adapted form of relaxation therapy or

stress management.

Moreover, an authoritative Clinical Review published by the British Medical Journal,

concludes:

It is estimated that around 80% of patients referred to tinnitus clinics can be helped

simply by relevant examination and reassurance. (Vesterager, 1997)


In other words, the majority of tinnitus sufferers seem to become increasingly habituated

to the sound simply by being reassured by a professional that it is not a symptom of any

underlying threat to their health, by being listened to empathically, and by being told that

they can expect to habituate over time.

It seems reasonable to assume, in the absence of any evidence to the contrary, that the

process of habituation should be indifferent to whether the intrusive stimulus (the sound) is

external or internal, i.e., whether it is LFN or tinnitus. Further weight is given to this

hypothesis by the observation that tinnitus habituation therapy seems to be equally

effective in different cases, regardless of the cause (Brattberg, 1983).) One leading

authority on tinnitus habituation concludes, on the basis of his clinical experience with over

a thousand clients,

The cause is often largely irrelevant when it comes to the therapeutic interventions you

will undertake. (Hogan, 1998).

Thus, if a treatment strategy is proven to assist sufferers in reducing tinnitus-related stress

there is no a priori reason to assume that the same interventions will not be effective in

helping LFNRS sufferers to habituate. If habituation works regardless of cause, it should

succeed even where the cause is external.

In the study already mentioned, (Andersson et al., 2002) a clinically significant reduction

in tinnitus symptoms (primarily in terms of reduced stress and annoyance) was recorded

in 31% of their sample group at one-year follow up. This was achieved by using an

internet based self-help programme, mainly employing relaxation techniques and some

basic CBT interventions.

There is encouraging research that self-hypnosis may be an effective treatment for

tinnitus, and therefore LFNRS. (Attias et al., (1993)) . 45 male patients suffering from

chronic tinnitus following an auditory trauma, were divided into three groups, assigned

treatment by self-hypnosis, masking, and attentiveness to their complaints by a third party

(i.e., listening skills, counselling). Surprisingly, whereas the masking technique used

(tapes of white noise) had no significant effect, the use of attentiveness to their complaints

had some benefit (supporting the role of "reassurance"), but self-hypnosis (from a tape

recording) achieved the best results, generating a significant reduction in the severity of

the tinnitus.


A similar study by Brattberg, (Brattberg, 1983).), measured the success of self-hypnosis

in tinnitus habituation. 32 patients at the Sandvikens Hospital in Sweden received an

initial one-hour individual consultation with a hypnotherapist, followed by four weeks of

daily practice with a 15 min. self-hypnosis tape recording (recorded live during the initial

session). The taped session combined relaxation therapy and positive suggestions:

The hypnotherapy was aimed at inducing the patient into as relaxed a state as

possible, and thereafter implanting the suggestion that the patient would no longer be

troubled by the noise. (Brattberg, 1983).)

22 of the patients (69%) reported that they were able to disregard the noise (i.e., had

achieved habituation) after the four weeks had elapsed. Three of the 32 (9%) reported a

complete cure of the tinnitus.

A study of biofeedback relaxation training (Podoshin et al., 1995) reported that 43.5% of

tinnitus sufferers experienced significant improvement of tinnitus symptoms when at rest,

24% when engaged in activity. Biofeedback is a specialist form of relaxation therapy used

in hypnotherapy and stress management.

Another study looked at the use of hypnotic trance in one-to-one sessions with a

hypnotherapist. Unusually, hypnosis was used purely as a relaxation therapy, without the

use of positive suggestions or psychotherapy interventions in hypnosis. Marks and

Onisiphorou (Marks and Onisisphorou, 1985)) found that of 14 patients who had proven

resistant to other forms of tinnitus treatment, five patients (35%) experienced significant

reduction in their level of distress (habituation); hypnotherapy "seemed to help them

tolerate their tinnitus better, although loudness and quality were unaltered."

4.5 Conclusions Most effective tinnitus treatment is concerned with habituation and stress reduction, rather

than remission of the tinnitus-sound itself. Tinnitus has many causes. It is believed that

habituation is equally effective regardless of the cause of the sound. The stress of LFNRS

sufferers is very similar to the stress of tinnitus sufferers; it is the cause and location of the

sound that is different. This simple observation would appear to suggest that the same

treatment strategies used in tinnitus habituation could benefit sufferers of LFNRS.


The most effective components of tinnitus habituation therapy appear to be i) reassurance,

ii) relaxation therapy. Therapeutic reassurance, in this context, takes the form of empathy,

listening, explanation, and advice. Therapeutic relaxation has been used in the form of

hypnotherapy, self-hypnosis tapes, biofeedback training, and CBT relaxation techniques.

Most clinicians would agree that there is considerable overlap between these techniques,

all of which could legitimately be classed as forms of "relaxation therapy", or even "stress

management."

Until this strategy of "reassurance and relaxation" therapy has been tested specifically with

LFNRS sufferers we cannot be certain that it will be effective. However, the a priori

indications from the clinical analogies with tinnitus habituation therapy are extremely

encouraging and certainly worth further research and investigation. Additionally. It may be

prudent, where possible, to check LFNRS sufferers for possible causes of tinnitus, such as

temporomandibular disorder (TMD) or other organic pathologies.

5.0 Subject selection. A database of subjects was available from the survey which had been carried out as part

of the earlier report for Defra (Leventhall et al., 2003). Those who lived within access to

London were telephoned and the project explained to them. Reponses varied from "I don't

hear the noise any more" to "The noise has made me too ill to travel to London". Some

would have liked to take part but were constrained by their work. However, there was a

good positive response

Additionally, letters were sent to the Environmental Health Departments of all 33 London Boroughs, explaining the project and asking to be put in touch with low frequency noise sufferers on their list. There was only one positive response from these and a further 40 letters were sent to outlying boroughs. These produced one other positive response.

Subject Age SexHearing problems

A 76 F Y

B 65 M N


C 69 F N

D* 69 F Y

E 56 F N

F 59 F N

G 71 M N

(H 75 M N)

I 72 M N

Table 2 Subjects who took part the relaxation sessions Subject E was in employment and F was self employed

Additionally, help was also sought from the "Low Frequency Help Line" (Rosemary Mann),

who sent a list of potential participants. There was some overlap between this list and the

database from the 2003 report. The low positive responses from the 73 boroughs which

were approached, probably with a population of over 10, 000, 000, may be an indication

of a current low level of complaints of low frequency noise

11 subjects were selected, most of whom were from the database of the 2003 report

(Leventhall et al., 2003) Two subjects dropped out before the relaxation sessions

commenced because of work commitments. The remaining 9 subjects are shown in

Table 2. One of these, subject H, did not complete the sessions.

The subjects have been prescribed the following medication, none of which are listed as

having a side effect on hearing or as producing auditory delusions

A None

B None

C Olanzapine 2.mg,(Antipsychotic), Temazepam 10mg. (Takes infrequently to help with sleep)

D Levothyroxine sodium tablets (Underactive thyroid)

E None

F Carbamazepine 200mg bd (Anticonvulsant, antipsychotic)

G Not at start of noise

H Finasteride tablets (Prostate) Atenolol tablets (Betablocker)

I Quetiapine 175mg at night (Antipsychotic)


6.0 Initial evaluation

6.1 Low frequency noise reaction questionnaire (LFNRQ). Following selection of the subjects, it was felt that distribution of a questionnaire before

the first meeting with them was desirable. The questionnaire would give the subjects'

responses with minimal influence from the project and also require a preliminary effort

from the subjects, as an indication of the seriousness of their feelings towards the project.

An existing Tinnitus Reaction Questionnaire (TRQ) (Wilson et al., 1991) was used as the

basis for the questionnaire. The TRQ gives a scale designed to assess the psychological

distress associated with tinnitus. 166 subjects in three different samples were used in its

development.

Sample 1 consisted of 37 subjects referred by an audiology department and who

had indicated willingness to take part in a study of biofeedback therapy and

relaxation training

Sample 2 consisted of 69 subjects referred to the audiology department of a

veterans' hospital

Sample 3 consisted of 50 tinnitus subjects who had volunteered their participation

following a radio programme on tinnitus

The questionnaire consisted of 26 questions requiring assessment of the negative effects

of tinnitus on a 5-point scale of: Not at all, A little of the time, Some of the time, A good

deal of the time, Almost all the time. Statistical analysis of the responses indicated that the

TRQ was consistent and stable and that it was a valid device for the assessment of

tinnitus-related psychological distress.

The original questionnaire was modified in the following ways:

Each question originally commenced with "My tinnitus has…." All questions were

changed to commence with "The noise has…" and the questionnaire was titled "Low

Frequency Noise Questionnaire"

An additional question No. 27 was added at the end to reflect some low frequency

noise sufferers statements that the noise drives them from their homes.


Three further general question permitted subjects to write down comments on their

noise and, finally, subjects were asked to list prescription drugs which they were taking.

The Low Frequency Noise Questionnaire is shown in Appendix 1.

6.2 Analysis of the results . The questionnaire was scored in the following way.

Each question answered was given a score from 1 to 5, where:

Not at all = 0

A little of the time = 1

Some of the time = 2

A good deal of the time = 3

Most of the time = 4

A question not answered was left blank in the scoring

Most subjects answered all of the LFNR statements, but one very stressed subject, H, did

not respond to 11 of the statements. Two others missed either one or two statements. The

detailed analysis of the questionnaire is given in Table 3 in Appendix 1. The results are

summarised in Figs 5 and 6.

Fig 5 shows the subject percentage score, from the columns under "Start" or S . The

columns under Finish or F are considered in section 8.1 . Scores were obtained in the

following way. Total score of maximum of 4 for 27 questions is 108. The score for each

subject is expressed as a percentage of 108. However, the score for subject H, who

missed 11 questions, is not representative of his condition. His percentage of 36% for the

16 questions which he answered does not give a true assessment of him. When taken as

a percentage of 64, rather than 108, the value is 61%, as indicated in Fig 6.1. The small

number of questions missed by some other subjects has little effect on their scores.


Some comments which can be made on Fig 6.1, in which the higher the score, the

greatest the adverse effect of the noise are:

Subject C is very stressed and chewed gum to relieve this

Subject D is also very stressed. This subject had had the low frequency noise

problem for only several months and had not been able to make any self adjustment.

The remaining subjects are more moderately affected, as they typically score 30% to

50%, which is between "A little of the time" (25%) and "Some of the time"(50%).

(Each step from "Not at all" to "Most of the time" is an increment of 25%)

Fig 6.2 shows the negative effects of the individual questions.

Question 23 (sleep disturbance) 72% and Q 12 (interfere with enjoyment of life)72%

are the most prominent effect.

These are followed by:

Q 14 (made hard to relax) 69%

Q 1 (made worry) 61%

Q 9 (annoyed) 61%

Q 2 ( made tense) 58%

Q 16 (made feel helpless) 58%

Q 13 (hard to concentrate) 58%

Q 20 (made avoid noisy situations) 58%

Q 3 (made irritable) 58%

Q 18 (interfered with work) 56%

Q 4 (made angry) 56%

The least adverse effects were

Q 6 (led to avoid quiet situations) 8%

Q 10 (made feel confused) 11%

Q 5 (made cry) 28%

Q 24 (made think of suicide) 28%


Q 25 ( made feel panicky) 28%

Consequently, the worst effects relate to sleep disturbance, interference with enjoyment,

relaxation, concentration and work, whilst leading to annoyance, anger, irritation,

helplessness and avoidance of noise.



Subject Scores LFNRQ

0

10

2030

40

50

60

7080

90

100

A B C D E F G H I

Subject

Perc

ent S

core

Fig 6.1 Subject scores LFNRQ

Fig 6.2 Question scores LFNRQ (without subject H)

0

10

20

30

40

50

60

70

80

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

Question number

Perc

ent s

core

6.3 Comparison with the Tinnitus Reaction Questionnaire The most adverse effects noted by Wilson (Wilson et al., 1991) in order were:

Interfered with work 50%

Interfered with sleep 47.5%

Interfered with concentration 47.5%

Interfered with enjoyment 47.5%

Hard to relax 47.5%

Made tense 42.5%

Made irritable 42.5%

The least adverse effects were:

Made cry 7.5%

Made think about suicide 7.5%

Made panicky 15%

Made feel helpless 17.5%

Led to despair 17.5%

Similarities can be seen between the effects of tinnitus and those of low frequency noise.

although tinnitus may score lower if it is accepted by the sufferer that an external agent is

not involved in the noise.

This comparison adds weight to the proposal to use psychotherapy techniques which have

been applied to help relieve the effects of tinnitus in order to assist low frequency noise

suffers to a condition of improved coping with their problem

6.4 Psychological tests. Each of the subjects (n=9) completed questionnaires, which assessed personality,

perceived Quality of Life (current), Quality of Coping and Quality of life (as estimated

before the onset of the noise). The primary aim was to build a profile of the subjective

experience for each subject for whom we could attempt to identify group core and common

features within this experience. In order to examine the extent to which individuals stress

levels had become associated with different types of noise, psycho physiological

measures of Galvanic Skin Response (GSR) and Heart Rate (HR) were taken while


Note that Wilson et al give their scores as average values. These have been converted to percentages out of 4, which is the maximum for each question. Thus an average of 2 is equivalent to 50%. This gives easier comparison with the results of Section 6.1

subjects were presented acoustic stimuli. The data from these measures provided an

indication of the degree to which changes in known stress parameters correlated with the

stimuli presented. The first stage of assessment entailed subjects to complete these tests

before any therapeutic intervention. The final stage of assessment entailed a re test

condition for the subjective Quality of Life measures and physiological parameters.

Personality profiles were elicited using the Insights tm Evaluator. This is a Jungian based

system and provides for an in depth and easy to read report on personality preferences,

interpersonal and communication style. Subjects each received a full personal report and a

general introduction to the model, at a group session.

The Quality of Life (Current) (Q of L) questionnaire (Appendix 2) addresses key areas of;

physical well being, coping, anxiety, emotional support and emotional well-being. The

Quality of Coping Questionnaire (Q of C) registered specific responses to individuals

perceived capacity to manage the noise and other competing demands (Appendix 3). The

Before Noise Quality of Life Questionnaire provided the subjects with an opportunity to

describe how they might have responded to the questionnaire before the onset of the

noise problem (Appendix 4).

The Quality of Life questionnaires, current and before noise comprised 27 and 21 items

respectively. Each of the questionnaires contained an option to respond within the

categories of Strongly Agree (SA), Agree (A), Neutral (N), Strongly Disagree (SD) and

Disagree (D) associated with each item.

The Quality of Coping questionnaire contained 8 questions and the same response format.

6.5 Quality of Life: Current

One of the strongest responses was with the issue of quality of life, where a direct

question of Quality of Life, produced an 88.9% agreement that subjects had been failing to

maintain their current Quality of Life. A key indicator of quality of life measures is the

degree to which individuals are able to relax and a counter indication of this is that of

anxiety. When asked if they felt anxious 62.5 % indicated they felt themselves to be

anxious. This may play an important role in the subjective impact of LFN, as it will combine

to influence the manner with which subsequent interventions may be judged. In order for a

measurement intervention to have an impact on the subjective quality of life it may well


need to first address the ‘subjective’ reality of anxiety. The impact of noise seems to

resemble that described by research into the impact upon personal projects. The noise

appears to take on the profile of a personal project, one that the sufferer cannot cut down.

The combined effect of the physical intrusion combined with failing behavioural coping

may extend the intrusive power of the stimulus into other psychosocial aspects of

individual’s lives. The ability to relax and to enjoy home activities were reported by 50% as

being inhibited and this combined with a 62.5% of the subjects reporting that they do not

sleep well suggests a corrosive environment, one likely to intensify pressure upon coping

over time.

The results from Table 6.1 offer an opportunity for some initial observations and

speculative comments.

Current Quality of Life and Anxiety Perceived CopingFeel sad 62.5% Dissatisfied with coping 37.5%Feel Anxious 62.5 % Cannot accept the noise 62.5%unable to have fun (relax) 50 % Worried: (A) losing hope 37.5%Discontent with Q of L 87.5 % (B) In a state of worry 62.5%Unable to sleep well 62.5% (C) Noise will get worse 50%

Table 6:1 Quality of Life Questionnaire

For example only 37.5% of the group reported that they were dissatisfied with their

capacity to cope with the noise while 62.5% were unable to accept and live with the noise.

This apparent tension was underlined by the majority description that they were unable to

stop worrying about the noise (62.5%).

With difficulties in sleeping, limited relaxation, feeling anxious and difficulties with

concentration at home, it seems that the home life of these subjects had deteriorated in

quality in a manner that interfered with recuperation and also focused attention. When

asked how able they were to concentrate at home, 75% scored that they were unable to

concentrate and 50% were worried that their condition would get worse over time.

Some of the strongest findings related to the questions concerning the capacity to adjust to

the noise. Subjects give a clear indication that their capacity to cope with the noise is

limited, with 62.5% showing that they have a hard time adjusting to living with the noise.


This combines with 50% finding that the noise makes them feel inadequate. These

findings describe an increasing vulnerability to anxiety and diminishing Quality of Life, with

individuals unable to develop quality time and behaviour at home.

The findings relating to the direct physical consequences of the noise experience is less

clear. Only 12.5 % reported that they had nausea while 32.5% reported headaches, which

they associated with the noise. Nor was there a strong indication that general health was

failing as only 25% felt ill. Although it is interesting that those recording feeling ill all

selected the ‘strongly agree’ option, suggesting that for these individuals health impact

was a serious concern. The strongest indicator concerning the physical health of the group

was found on the item shown in Table 6:2.

Frequency Percent

Strongly agree 3 37.5

Agree 2 25

Disagree 2 25

Strongly disagree 1 12.5

Total Subjects 8 100.0

Table 6.2 I am bothered by side effects of treatment

In response to this item 62.5% were bothered by the side effects of the treatments, which

they had been prescribed in order to better cope with the noise. The medical interventions

appear to contribute to the overall level of concern and worry, which are likely to

undermine individuals coping rather than improve it.

The general level of emotional support, found in table 7.3 was good for more than half of

the group, reflecting over half of the group’s feeling that they and their noise problem was

accepted and understood by their family. Importantly, 75% felt that they felt close to their

partner, their main support. Given the low Quality of Life recorded this support probably

took the form of providing comfort rather than solutions. What is clear is the degree to

which sufferers need and value emotional support and may have contributed to why only

two of the group were dissatisfied with how they were coping with the noise.


Frequency Percent


Agree 2 25

Disagree 3 37.5


Table 6.3 I get emotional support from my family

The general reported Quality of Life was shown to be of real concern to the group and of a

generally low level, while anxiety was high and sleeping disturbed. These responses

combined with a high degree of worry about the noise and its continued effects all serve to

characterise subjects quality of Life as poor and likely a confounding influence on the

effectiveness of current interventions. Clearly, any support for subjects condition from

existing medical interventions were seen compromised by the strength of the associated

anxiety and worry.

6.6 Quality of Coping Questionnaire:The second questionnaire completed by the subject group comprised items related to

personal coping. The results in Table 6.4a and 6.4b show the responses to items that

addressed individuals assessment of their present state of coping and the quality of their

ability to manage living with the noise.

Current Quality

Frequency Percent


Neutral 1 12.5

Disagree 2 25


Table 6.4a I have a hard time adjusting to the noise


Frequency Percent


Agree 1 12.5

Neutral 1 12.5

Disagree 2 25

Strongly disagree 3 37.5


Table 6.4b The noise does not make me feel inadequate

Table 6.4 Current Quality and Capacity to Cope with the Noise

With 62.5% scoring a strong agreement with the adjustment item and a similar tendency

scored for feelings of inadequacy (57.5%), indications are that current quality of coping is

low and it is likely that the associated level of stress would be high. However, the level of

expectation that something can be done to improve the situation is robust with a fairly even

spread of perceptions within the group as shown in Table 6.5.

Future Expectations:

Frequenc

y

Percent


Agree 2 25

Neutral 2 25

Disagree 3 37.5


Table 6.5 I will never cope with the noise well enough to make me happy

Although the general level of coping was not good, the group still displayed a resilient

attitude to the situation; indicative of a strong need to re assert control over their personal

environment.

Feelings of Social Isolation:


Although the partner/main support relationship was viewed as central to most subjects,

this probably reflected a dependency supported through a mutual bond, which existed

Frequenc

y

Percent


Agree 1 12.5

Neutral 1 12.5

Disagree 1 12.5

Strongly disagree 2 25


Table 6.6 I think that people are often uncomfortable being around me because of my problem with the noise

beyond the noise, rather like that initiated in response to an illness. However, the broader

social network seems to pose further demands upon at least half of the group as shown in

Table 6:6.

6.7 Quality of Life: Before and After Noise Comparison

All group members also completed a questionnaire that allowed them to assess items

against their impression of how they would have scored that item before the onset of the

noise as in Fig 6.7. The Quality of Life (Q of L) questions are shown in the Figure.

The data in Fig 6.7 has been plotted to show the number of subjects who selected 'agree'

or 'strongly agree' to the items. For example when asked to compare the previous level of

energy (that before the noise onset), seven selected strongly disagree (SD), one selected

disagree D) and one the neutral option. This was plotted as one subject that ‘might’ have

been able to select an agreement to the question. For comparison, subject’s selections on

the current Quality of Life questionnaire (Appendix 2) were plotted from the two Strongly

agree (SA) and three agree (A) that gave a total of five subjects that had earlier decided

that agreement to this item accurately reflected their experience. In an effort to achieve a


degree of robustness with this level of data, any scores for neutral, for the before noise

questionnaire, were not included as evidence for an item.

Q 1 I have lack of energyQ2 I have nausea

Q3 Because of my feelings of fatigue I have trouble meeting the needs of my family

Q4 I experience bad headachesQ5 I feel illQ6 I am forced to spend time in bedQ7 I feel sadQ8 I feel anxiousQ9 I feel close to my friendsQ10 I am able to concentrate at homeQ11 My work at home is fulfillingQ12 I am able to enjoy lifeQ13 I am sleeping wellQ14 I am enjoying the things I usually do for funQ15 I am content with the quality of my life right now

Figure 6.7 Quality of Life Ratings: Before and after onset of the noise


0

1

2

3

4

5

6

7

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Quality of Life Questions

Num

ber o

f sub

ject

s

Before

After

The comparison of ratings seems to show a picture of a home environment being stripped

of control, relaxation and enjoyment. The loss of sleep and degraded capacity to

concentrate are just two items, which when combined create an interactive and corrosive

process that inhibits recuperation, while elevating anxiety and thereby undermining the

individuals sense of well-being. Clearly the quality of mood-state was perceived as

deteriorating as both the sadness and anxiety items display marked divergence across the

before and after noise conditions.

Perhaps the strongest aspect of these findings can be found in the recognition of the

chronic nature of the situation within which individuals find themselves. As the key Quality

of Life elements are distorted and fail, the individual may start to lose hope, which would

only serve to exacerbate the already emotionally corrosive situation. The general trend is

pronounced, with the key indicators for self rated Quality of Life showing a marked decline

when compared with the Quality of Life recorded by subjects before the noise onset. Even

allowing for an element of idealisation in subjects' perception of their lives before the onset

of noise, the noise produces a clear shift towards the less favourable aspects of their lives,

which lie at the left of Figure 6.7.

6.8 Personality Questionnaire: Insights Discovery Evaluator.Each subject’s profile position is shown in Figure 6.8 as a large dot. In broad terms the left

hand side of the wheel represents the introverted personality and the right hand side the

extraverted. All but two of the subject’s scores placed them in the introverted half. The

Jungian system is comprised of two attitudes (introversion and extraversion) two rational


functions (thinking and feeling) and two irrational functions (sensing and intuition. In

combination this classification provides a basis for differentiating between eight

fundamental types, as shown in summary in Appendix 5

It can be noted that subjects C and D, who appear at the right of the wheel, showed high

scores on the LFN Reaction Questionnaire. Subject C was sensitive to all noise and very

distressed at the start of the sessions. Subject D, who said that her normal personality

was outgoing and ebullient, had been driven to tears by the noise and become subject to

panic attacks. The remaining subjects, at the left of the wheel, were more subdued in their

responses, although felt just as keenly.

The Jungian model, which generates this classification, shown in position on the wheel in

Fig. 6.2, includes a consideration of how individuals prefer to organise and cope with

incoming information. The dimension along which this preference is measured is that of

‘sensing’. Individuals who score highly along this dimension tend to be comfortable

organising information around specific and a ‘here and now’ basis. Individuals scoring

highly on this dimension would, according to the Jungian model, often want specific

information, such that making sense of the current environment is enhanced. There is a


predicted heavy dependence upon the senses for perception rather than internalised

abstraction. The Jungian model would predict that such individuals would be heavily

inclined to build models of the world, from which coping would follow, which were based

upon a need for trustworthy information. For these individuals, trustworthy information

would be strongly influenced by the quality of the sensory information available. Any

decline in the level of ‘trustworthy’ sense based information (for whatever reason), would

undermine their fundamental reliance upon the preference to verify, directly and

concretely, information.


© Andrew Lo th ian, In sights, D undee, Sco tland, 2003 . A l l r ights reserved.IN S IG H T S, IN S IG H TS D ISC O VER Y and IN S IG H T S W H EEL are registered T rade M arks.Insights Ign it ing Corporate S pirit

LFN

G W

IB

Blue/G reen (Introverts) R ed/Y ellow (E xtraverts) F igure 6. 2 Personality T ypes for the L FN G roup (n=9)

Subject Identifier – clockwise from the top. Outer ring: C , I Centre ring: D,A,H,G,B Inner ring: E,F

Individuals whose preferred route towards coping with incoming information, one that

reflects a preference for concrete evidence/examples and a dependence upon the here

and now for verification of events ("believe it when I see it") seem to represent the majority

type for this sample. Failure to be able to control sensory information is probably

disturbing for most types of individuals. However, for this group the Jungian model would

suggest that failure to control such sense-based events would tend to undermine the

personal strategies preferred by these individuals when seeking to cope with

environmental demands.

The inability to establish control over the sensory environment would inhibit any

accommodation to changes to the composition of the noise situation within which they

found themselves; the ability to "simply get used to it" would be inhibited and remote. For

these types, accommodation to changing sense data is conditional upon re-establishing

control and their sensitivity to the noise impact would likely ‘increase’ over time as duration

would prompt further evidence of unwanted intrusion, almost irrespective of the sound

level

6.9 Physiological Parameters: ResultsThe Power Lab computer based system with Electro Dermal Activity (EDA) and Heart Rate

(HR) monitoring facility was combined with a software based sound generator to measure

subjects’ physiological responses to acoustic stimuli. The Basal rate (BR) was measured

and stimuli presented in a pseudo-random order and the physiological parameters were

measured for comparison with the individual’s basal rate. Stimulus duration was for three

minutes and all measures were non invasive.

Stimuli used:White Noise (WN)

70Hz,Pure tone (70 LFN)

Narrow Band Moderate, (Frequency range 150Hz-250Hz)

LFNNR (Frequency range 52Hz-125Hz)

Target (Stimuli attempting to match that experienced by the subject at home)

The subjects were each subjected to acoustic stimuli at a level that was ‘comfortable’ for

them to hear the sound. All stimuli were pre-selected except for the target. The target

stimuli matching produced a range of frequencies from 150Hz – 300Hz. Each stimulus

presentation was preceded by a period necessary to see the base rate re- established.


Electro dermal Activity (EDA) (Fig 6.3)The findings present a mixed picture; with a clear differentiation between stimuli and basal

rate (no noise) conditions, yet an unclear separation between acoustic stimuli. Any

Fig 6.3 Relative electrodermal activity – subject averagesmeasurement of stimulus specific impact has been contaminated by a large amount of

variance in the data. One subject’s extreme response was enough to overwhelm any

trend. However, Narrow Band Moderate condition appears to have a robust effect upon

subjects EDA.

Heart Rate

Fig 6.4 Heart rate – subject averages

The results for HR show that the 70Hz LFN and the target stimuli were capable of inducing

higher levels of physiological activity. This offers some support to the view that subjects


EDA

0

2

4

6

8

10

12

BR WN 70LFN NBMOD LFNNR TARGET

HR

0

20

40

60

80

100

120

140


had acquired a conditioned response to their target stimulus and this led to elevated

physiological response, a clear marker for stress.

7.0 The Relaxation sessions7.1 Introduction

The term "low frequency noise related stress" (LFNRS) has been adopted to refer to cases

where psychological distress is caused by low frequency noise. This includes both cases

where no source has been found for the intrusive noise (often called "the Hum") and also

cases where it is believed that the source of the sound has been identified. It excludes

cases where there is a low frequency noise which is not causing distress.

The first stage of the project, from the clinical point of view, was to review the existing

literature in an attempt to identify relevant therapeutic strategies and protocols. (See

section 4) It was clear at an early stage that a therapeutic strategy, based upon certain

clinical analogies with similar or related issues, would have to be developed. There was

no identifiable research which specifically dealt with the treatment of LFNRS, Therefore

primary investigation was given to the treatment of tinnitus, as a number of research

studies in this area were identified, which seemed to offer indications for the treatment of

LFNRS.

7.2 Rationale for Treatment Plan It was inferred from the research on tinnitus treatment that the stress reaction to the sound

(whether tinnitus or LFN) could be treated by a combination of three basic therapeutic

strategies.

1) Reassurance, explanation, and support.

2) Relaxation therapy techniques.

3) General stress management advice and exercises (coping skills).

It was also hypothesised, based on the clinical analogy with phobia treatment, that some

form of imaginal exposure therapy might help participants to desensitise, i.e. habituate to

the sound. Hence,


4) Imaginal exposure using "anchoring" of relaxation.

The final intervention constituting a later phase of treatment developing out of the

acquisition of basic relaxation skills.

7.3 Group Structure and Attendance. The therapeutic interventions used in the project have been delivered by means of a series

of six two-hour group workshops. During the workshops participants were assigned time

to discuss their feelings about LFNRS and related issues, were given information and

advice about heightening understanding of their symptoms and taught coping skills. A

range of coping skills were discussed and practised, but the key intervention was a version

of the Benson Relaxation Response Method (Benson, 1975; Benson and Stuart, 1996).

This is an evidence-based relaxation therapy technique widely used in stress management

and psychotherapy. The Benson Method was taught and rehearsed in each session,

supported and reinforced with other relaxation techniques derived from psychotherapy and

self-hypnosis. Participants were given handouts explaining it as a protocol and assigned

the homework of practising it twice daily for twenty minutes, feeding back on their

experiences at the start of each subsequent session. Participants were also given a

generic stress management CD, recorded by Donald Robertson, containing a number of

common relaxation exercises to supplement their use of the Benson Method.

Donald Robertson, an integrative psychotherapist, designed and facilitated the workshops.

Donald is a specialist in hypnotherapy and teaching self-hypnosis and relaxation

techniques.

An osteopath and integrative bodywork therapist, Joanne Treherne, attended the first three

workshops. Joanne was present because the preliminary research on tinnitus and related

issues had suggested that it might be worth assessing the group for a physical condition

called temporomandibular disorder (TMD). It was originally planned to merely touch briefly

on TMD in the first session, but Joanne's initial assessment suggested that there were

indeed unusually high rates of TMD-related symptoms among our group.

Geoff Leventhall attended most of the workshops, primarily to observe and assist in

discussions relating to the organisation of the project and to maintain contact with the


subjects. Steve Benton attended one workshop to observe and discuss the results of

some of the preliminary psychological assessments with the participants.

The group of participants was composed of nine sufferers from LFNRS. One participant,

who was susceptible to panic attacks, was accompanied by her husband, making a tenth

participant, whose presence was requested by her for emotional support. He participated

in the exercises and provided useful feedback and comments from the perspective of

someone observing a sufferer at close quarters. However, as he was not himself a

sufferer, he has not been included in the formal assessment of the group.

Most group members have attended each workshop session. However, some have

missed sessions because they were unable to attend on particular dates. We anticipated

that this would happen in the design of the project and believe that those participants who

have missed one or two sessions should still be in a position to benefit sufficiently from

their attendance at other workshops, provided they have maintained their commitment to

the homework assigned.

7.4 The Benson Relaxation ResponseIn 1960, at Harvard Medical School in the US, the cardiologist Herbert Benson developed

the “Relaxation Response” approach to stress therapy. Benson’s research into human

physiology showed that in addition to the established ‘fight or flight’ response, the body

possessed the ability to deliberately induce a counterbalancing state of physical rest and

emotional calm which he labelled the ‘relaxation response.’

When the mind is focused, whether through meditation or other repetitive mental

activities, the body responds with a dramatic decrease in heart rate, breathing rate,

blood pressure (if elevated to begin with), and metabolic rate - the exact opposite

effects of the fight-or-flight response. (Benson, 1975: 9)

Benson discovered that the relaxation response could be elicited in a number of ways,

using established relaxation techniques from yogic meditation to progressive muscle

relaxation. Once he had established the existence of a measurable and clinically

significant relaxation mechanism, Benson proceeded to search for the simplest possible

protocol capable of inducing it. He concluded that the relaxation response could be

elicited by a combination of two essential factors:


1. A monotonous mental stimulus. That is, a sound, word, phrase, or prayer repeated

silently or aloud, or a fixed gaze at an object.

2. A passive mental attitude. Not worrying about how well one is performing the

technique and simply putting aside distracting thoughts to return to one’s focus. (Benson,

1975: 10)

Consequently, Benson developed his own protocol which generally involves the subject

sitting in a comfortable chair with their eyes closed and repeating a simple word, such as

“one” or “peace”, on each exhalation of breath. This is usually done for 10-20 min. twice

per day, on an ongoing basis.

The DEFRA group of LFNRS sufferers were taught how to use the Benson Method by

means of group exercises facilitated by Donald Robertson. They practised the technique

at home and discussed their experiences at the start of each session, where time was

allocated to coach them through any difficulties in technique and to answer their questions

and offer emotional support, reassurance and encouragement.

The Relaxation Response protocol, sometimes known as the “Benson Method”, is

currently one of the most popular relaxation techniques in modern stress management and

psychological therapy. It is often used in conjunction with cognitive-behavioural

therapy (CBT) (Beck, 1976) and other solution-focused and evidence-based interventions

in psychological therapy.

A recent clinical literature review published in the British Medical Journal (BMJ) outlines

some of the most reliable research evidence on the effects of relaxation techniques like

the Benson Method and self-hypnosis.

There is good evidence from randomised controlled trials that both hypnosis and

relaxation techniques can reduce anxiety, particularly that related to stressful

situations [...]. They are also effective for panic disorders and insomnia, particularly

when integrated into a package of cognitive therapy [...] (Vickers and Zollman,

1999)


Anxiety, panic attack, and insomnia are typical stress-related symptoms, which were found

to be particularly common among the sample group of LFNRS sufferers, and which are

believed to be frequently encountered among LFNRS sufferers in general.

7.5 Principles of Relaxation Therapy“Relaxation therapy” is a broad term that encompasses a range of different therapy

interventions. However, most of these techniques are essentially highly directive and

systematic processes which exhibit measurable physiological results, and can therefore be

considered as a form of behaviour therapy. Most forms of relaxation therapy are

evidence-based and reasonably well accepted - though that does not mean widely

practised - within mainstream medicine. In that respect they can legitimately be

considered as a branch of “orthodox” therapy rather than “complementary and alternative

medicine” (CAM). That is, "Relaxation" and “Stress Management” are found to a certain

extent within conventional medicine.’ (Vickers and Zollman, 1999). The BMA define

‘relaxation techniques’ as follows:

Methods of reducing muscle tension to achieve mental calm. Can assist people with

anxiety, help reduce hypertension, and relieve stress. (BMA, 2002)

Most forms of relaxation therapy entail teaching clients specific coping skills designed to

induce the relaxation response in the body. There are a number of different ways of

achieving this, e.g., progressive muscle relaxation, guided visualisation, meditation, self-

hypnosis, breathing exercises, contemplative meditation, etc.

When relaxation techniques are taught by a facilitator or therapist, the results tend to be

more pronounced. This is partly because simple processes, such as the Benson Method,

can be combined with longer and more sophisticated exercises facilitated by the group

leader. For instance, the LFN group were “talked through” lengthy progressive muscle

relaxation exercises and visualisation techniques which led into the practice of the Benson

Method which they were instructed to use at home. This meant that they were already in a

fairly relaxed state before commencing the part of the exercise which they were to repeat

at home. When they then practised the Benson Method between sessions, they could

recall the relatively deep levels of relaxation which they were coached into during the

sessions, making it easier for them to make progress in developing their coping skills for

relaxation.


The effects of deep relaxation are numerous. For example, in their advice book on stress

the British Medical Association, assert that systematic relaxation, "Improves sleep,

increases mental and physical performance, combats tiredness, decreases anxiety and

tension" (Wilkinson, 2004). Essentially, it evokes a physiological and psychological state

which is the opposite of, and mutually exclusive with, the state of stress, including the kind

of stress that appears to result, in certain cases, from exposure to LFN.

One advantage of this approach is that it is well suited to group work as well as individual

therapy. This obviously makes it easier to carry out research on efficacy, and renders the

therapy more cost-effective to deliver.

In addition to dealing with the symptoms of LFNRS, an attempt was made to induce the

process of habituation to the low frequency noise stimulus by means of a process of

“imaginal exposure” otherwise known as systematic desensitisation, described as:

A technique of behaviour therapy, developed in the 1950s by the South African-born

US psychiatrist Joseph Wolpe (1915-97) for treating phobias in particular, in which

each member of a hierarchy of increasingly anxiety-provoking imaginary situations

involving the phobic stimulus is repeatedly paired with a response that is

physiologically incompatible with fear and anxiety, such as deep muscular relaxation

[...] (Colman, 2001)

The clinical analogy with phobia treatment was assumed, as many of the LFNRS sufferers

described their reactions to LFN in terms which resembled phobia. Once group members

had mastered the basics of relaxation therapy an element of imaginal exposure was

introduced by guiding them through the process of imaging themselves to be in the place

where the sound typically occurs and remembering the sound and any accompanying

sensations (often described as “vibrations”), while maintaining and reinforcing their sense

of emotional calm and physical relaxation. This was done repeatedly in an attempt to

neutralise the anxious and stressful feelings associated with LFN by pairing it with the

relaxation response.


7.6 Group Dynamic & Characteristics One of the most interesting aspects of the project has been the opportunity to informally

observe how the LFNRS group interacted with each other, the exercises they were given,

and the workshop facilitators.

Group members were eager to discuss their symptoms and exchange information on

possible causes and related issues. This meant that more time than we had anticipated

had to be allocated to group discussion at the beginning. These discussions related to

issues such as difficulties dealing with noisy neighbours, local authorities, as well as health

issues, etc. It was necessary for the group to feel that they had been listened to and given

an opportunity to air their concerns, as to prohibit such discussion may have caused them

to feel undervalued or ignored. However, there was also concern that allowing the group

to focus too much on these concerns might distract them from the planned therapeutic

process of working on their own psychological reactions to LFN. Fortunately, the desire to

discuss such "external" issues gradually reduced until by the fourth session very little time

was required for discussion other than that related to the therapeutic process itself.

The number and variety of potentially stress-related symptoms among the group was

notable. For example, group members complained of, or exhibited behaviour, which might

be interpreted as paranoia, sleep problems, anger management problems, panic attacks,

tremors, headaches, TMD symptoms, etc. We also noted that several group members

reported a range of other hearing-related issues, e.g., tinnitus, hyperacusis and hearing

impairment (deafness). The group also contained a number of members who had either

resorted to, or considered, litigation in relation to their low frequency noise problem.

Another interesting development was that, when group members were encouraged to

discuss and compare their symptoms, it became clear that they experienced LFN in a

number of ways. Of note was the fact that three group members said that they were more

distressed by feelings of vibration, which they associated with LFN and other sounds, than

by the sound itself. It is highly unlikely that LFN of the levels encountered could directly

cause a physical vibration of this kind.1 Sometimes, not surprisingly, participants found it

quite difficult to explain the stimulus or its effects and expressed frustration with the

inability of non-sufferers to comprehend their experiences.

1 Many of the group had had measurements taken to locate the noise, generally without a positive outcome, which is typical of the Hum.


7.7Temporomandibular Disorder (TMD). The temporomandibular joint (TMJ) is the

joint that connects the jawbone to the skull. It is therefore situated very close to the inner

ear. TMD occurs when the TMJ becomes damaged or irritated. It is generally caused by

misuse of the jaw muscles, such as excessive tension in the jaw or bruxism (compulsive

tooth grinding or clenching).

Although methods for diagnosing TMD vary in their results, it is widely believed that TMD

is extremely common among tinnitus sufferers and may be one of many causes of tinnitus.

Our attention was drawn to the possible connection between TMD and LFNRS because of

a case study of self-cure of LFNRS symptoms in private correspondence with a sufferer

who had apparently identified TMD in themselves and cured some of their symptoms by

rectifying their TMD and by using self-hypnosis for relaxation.

Osteopath Joanne Treherne carried out an assessment of the group over three sessions

by:

1) Informal observation of them during sessions.

2) Completion of a short assessment questionnaire.

3) Short physical assessments of each of the participants using osteopathic methods

for diagnosing TMD.

The assessments suggested that most of the group were exhibiting symptoms of TMD. In

some cases, when pointed out, dysfunction in the jaw of group members, such as

misalignment, was clearly visible even to a layperson.

Table 7. 1: Partial TMD Results

Key: “None“, “Mild“, “Moderate“ (Mod) , “Severe”

Subject A B C D E F G H ISymptom level

Mild Mild Mod None None Mod Mod None Mild

TMD could be either a cause or effect of LFNRS, or both. On one hand, severe stress,

such as that caused by LFNRS, can often cause bruxism, which leads to TMD. LFN

could cause TMD. On the other hand, TMD appears to be a cause of tinnitus and


possibly other hearing-related problems, so it may also be a cause of sensitivity to LFN.

TMD could possibly cause the LFNRS.

Lifestyle factors play a role in developing TMD. For example, it was of note that, initially,

one group member frequently chewed chewing gum (even during the relaxation sessions),

which is a common contributing factor to TMD. However, the most common cause is

stress and one possible treatment is relaxation therapy combined with heightening

awareness of the function of the jaw and its possible misuse. For this reason, care was

taken to explain and demonstrate the function of the TMJ to participants, e.g., explaining

that the teeth do not normally touch when the jaw is relaxed. Being aware of this and

other factors can help in developing and maintaining an appropriately relaxed state in the

TMJ, especially when such knowledge and self-observation is combined with the

systematic relaxation techniques being taught as part of the project.

7.7 Anxiety and DepressionAnxiety and depression are common correlates of stress, which were assessed as part of

the clinical component of the project. The Hospital Anxiety and Depression Scale (HADS)

is a widely used and convenient model of assessment, using a set of 14 multiple choice

questions. Only five of the group completed the forms and returned them, one

anonymously. Subjects C and D, who showed highest scores on the HADS scale, were

the group members who appeared to be most affected by the noise.

Subject

Anxiety Score

Anxiety Level

Depression Score

Depression Level

A 4 Normal 2 Normal

B 5 Normal 5 Normal

C 9 Mild 6 Normal

D 17 Severe 11 Moderate

ANON 10 Mild 10 Mild

Table 7.2 Partial HADS Results

These scores indicate that two of the subjects who returned the forms did not exhibit

symptoms of anxiety or depression on the HADS scale. However, the other three

exhibited relatively high scores for anxiety and slightly lower, though still significant, scores

for depression. An informal impression, though, was that the overall levels of emotional


distress among group members was much higher than that indicated in these responses. It

is possible that there was a reluctance, amongst the subjects, to divulge the extent of their

problems.

7.8 Group Feedback & EvaluationFour further sessions were arranged in addition to the original six which were planned at

the beginning of the project, as it was felt that the group participants would benefit from

further assistance. At the first of these sessions, a form entitled ‘Group Participants’

Evaluation Form’ was completed, which was designed to assess satisfaction levels and

further identify group members’ comments and feedback on the process. In addition to

written comments on the workshops, participants were asked to answer the following

question by marking the scale shown.

Q: “How satisfied are you with the help provided in the workshops?”

(Not satisfied at all) 0 1 2 3 4 5 (Completely satisfied)

The results are shown as percentages in Fig 7.1 in 20% steps.

Two group members made additional comments on the satisfaction scale. Participant B

explained that, although very satisfied with the content of the workshops, he felt that they

were not extensive enough in scope. From his other comments, we interpret that he

meant he was dissatisfied with the fact that the therapy sessions did not attempt to identify

potential external sources for the sound.

Similarly, participant A commented that she was “completely satisfied” with the workshops

for what she referred to as “general therapy”, but also indicated “not satisfied at all” next to

which she commented “if it were dealing with my problem.” Our interpretation - based on

her other comments - is that she found the sessions useful for managing the symptoms of

stress associated with LFN, but that she was disappointed that the therapy sessions did

not offer help in identifying and eliminating possible external sources of the sound itself.

The subjects' comments are included in Section 9.0

The primary aim of the workshops was to deal with the general stress resulting from LFN.

However, it was explained that, in some cases, this might possibly result in changes to the


perception of the sound itself, such as reduction in awareness of the sound or in volume,

as is the case in a small number of cases where tinnitus sufferers habituate to their sound.

Considerable emphasis was placed throughout on the fact that the workshops were

primarily designed to deliver psychological therapy rather than to offer assistance in

identifying possible external causes of LFN.

Another group member, E, suggested that perhaps a second group could be formed to

facilitate discussion of possible external causes of LFN.

Other specific comments made by participants on the feedback forms included the

following. Three people said they found the Neural Linguistic Programming (NLP)

technique known as Visual-Kinaesthetic Dissociation (VKD) helpful. Group members were

introduced to this technique as part of a “menu” of possible coping skills for their

evaluation. Four people specifically mentioned that they found the Benson Method helpful.

Two people noted that the Stressology stress management CD had been helpful. Three

people commented on the importance they placed on actually identifying the external

source of the sound. Four people mentioned that they found it helpful to meet and speak

with other sufferers. Two people mentioned that they found the use of white noise or

pleasant background sounds useful for masking the LFN.


0

20

40

60

80

100

Perc

ent R

atin

g

A B C D E F G I

Fig 7.1 Group satisfaction scores

7.9 Conclusions

The small number of subjects limits the reliability of statistical deductions, but anecdotal

evidence based upon subjects comments and responses to questions during the sessions

suggests that the majority of group members, and possibly all of them, felt significant

improvement in their levels of stress associated with LFN. The high levels of adherence to

the programme and attendance at sessions was surprising, and indicated that the

participants placed considerable value upon the treatment they were receiving. . Only one

group member dropped out, at a very early stage, from the project.

The importance of striking a balance between allowing group members to air their

concerns about the legal and social issues surrounding the possible sources of LFN on the

one hand, and keeping them focused upon improving their internal reactions to it on the

other, became very obvious over the first few sessions.

Comments by subjects are given in Appendix 8

8.0 Follow-up tests

8.1 Low Frequency Noise Reaction Questionnaire RepeatAt the end of the six relaxation sessions, subjects were asked to complete again the same

questionnaire as that discussed in Section 6 and shown in Appendix A. Questions 1 to 27

were the same, but questions 28 to 30 were replaced with a single "Please add any

general comments which you wish to give about the project, how it might be improved for

further use and how it has helped you". The scores for the repeat questionnaire are

included in Table 1, Appendix 1 for each subject in the column for the "Finish" of the

project.


Fig 8.1 is a comparison of the subject scores before and after the six relaxation sessions.

A general reduction in adverse effects, or no effect, can be seen, of Fig 7.1 in Table 8.1,

which shows that a high satisfaction is not necessarily related to a reduction in LFNRQ

scores.

A B C D E F G ISatisfaction score %

100 80 100 80 80 80 60 80

% change in LFNRQ

+2 -10 -32 -9 -18 -16 +18 +2

Table 8.1 Comparison of Satisfaction Score and reduction in LFNRQ response


Fig 8.2 shows the percent questionnaire scores across questions, for all subjects, before and after the relaxation sessions and indicates the main changes.

8.2 Post Therapy Ratings: Quality of Life Questionnaire (Q of L) Subjects were asked to complete the Q of L questionnaire (Table 8.2) after the series of

therapeutic sessions. The answers to the questions are shown in Figure 8.3, combined

with how subjects believed their Q of L was before onset of the noise, how it was initially

with the noise and how it was after relaxation therapy. Ratings for ‘After Relaxation

Therapy’ were calculated on the same basis as that for the results shown in Fig. 6.1,

Section 6.7

The overall percentages for the Quality of Life Questionnaire are shown in Table 8.2

NANR125 Leventhall Draft 8

Figure 8.3 Comparison of Quality of Life Ratings before and after Therapy.

0

10

20

30

40

50

60

70

80

90

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

Perc

ent s

core

Question number

Fig 8.2. Questionnaire scores across questions before and after the relaxation sessions.

Main reductions. Q3 – irritable, Q4 – angry, Q9 – annoyed, Q11 – Drives crazy, Q12 – interfered with enjoyment Q14 – Hard to relax, Q25- panic, Q26 – feel tormented

Main Increases. Q1 – worry about noise, Q10 – feel confused Q20 - avoid noisy situations

Before After

62

Question After noise onset %

After relaxation therapy %

1. I have lack of energy 50 50

2. I have nausea 50 12.5

3. Because of my fatigue I have trouble meeting the needs of my family

37.5 25

4. I experience bad headaches 37.5 25

5. I feel ill 25 12.5

6 I am forced to spend time in bed 12.5 0

7. I feel sad 50 12.5

8. I feel anxious 62.5 25

9. I feel close to my friends 50 50

10. I am able to concentrate at home 12.5 25

11. My work at home is fulfilling 37.5 12.5

12. I am able to enjoy life 25 25

13. I am sleeping well 12.5 37.5

14. I am enjoying the things I usually do for fun 12.5 50

15. I am content with the quality of my life right now 0 0

Table 8.2 Quality of Life Questionnaire (12.5% = 1 subject)


Fig 8.3 Comparison of Quality of Life ratings before and after therapy

0

1

2

3

4

5

6

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Question number

Num

ber o

f Sub

ject

s

Before After

63

The ratings from subjects after the therapeutic intervention show a change compared with

section 6.7. If the ratings can be taken as commentary on aspects of subjects' quality of

life, it can be seen that a number of aspects have improved. Subjects report that that, in

general, their physical well being ( Q2 , Q3, Q4, Q5, Q6, Q7 and Q8) all show signs of

improvement. The ratings for question 1(energy) do not show improvement for the group,

which in itself may not appear a strong indicator of improvement. However, when ratings

for questions 1-8 are examined together a trend towards decreasing negatives and

increasing positives emerges.

Subjects report a continual battle against the noise and its intrusions. Many of the subjects

have a long-term history with the noise and so it is against this well-established tendency

that encouraging gains have been recorded.

The impact upon subjects’ quality of emotional life seems to be most marked as in

questions 7 and 8. This is an important indicator of improvement as the capacity to re-

assert control over the impact of unwanted stimuli is central to effective coping. The more

effective the individual’s coping the more likely that their mood will improve and confidence

increase, leading to lowering of anxiety.

The responses to question 11 were not consistent with the general trend towards

improvement as AFTN positive scores was 37.5%% compared with AFRT scores of

12.5%.

Subjects’ reports suggest evidence for increased capacity to relax and to replenish energy

levels – questions 12 – 14. This is a significant move towards breaking the downward

quality of life, which characterizes LFN complaints and accentuates stress, but none of the

subjects is content with quality of life.

Given the relatively short duration of the relaxation sessions it does seem that subjects

have been able to build an improved quality of life as the result of applying control

techniques. Subjects’ ratings indicate decreased sensitivity to the noise, and increased

coping. The quality of home life appears to have improved given the trend for improvement

found in questions 13-14.

8.3 Post Therapy Ratings: Coping QuestionnaireIf quality of life measures were showing an improvement, then the underlying mechanism

was likely to be improved coping. Subjects’ scores on the coping questionnaire indicate

stronger positive perceptions. For example, ratings of ‘I have a hard time adjusting to the


noise’ (Q.1) showed a 25 % agreement compared to a 66.7% agreement before the

therapeutic intervention. The techniques acquired by subjects from the therapy sessions

seem to have initiated perceptions that help to counter the negative effects of failed

coping. When asked to consider their longer term capacity to cope with the noise (Q.7)

87.5%, compared with pre session of 37.5 % ,thought that they would now be able to

regain happiness.

The quality of coping questions and responses are shown in full in Appendix 3. Answers were given on a 5-point scale from Strongly Agree to Strongly Disagree

Selected result are:

Q.7 Future Expectations: I will never cope with the noise well enough to make me happy

After noise onset After relaxation therapy

Disagree 37.5% 87.5%

This improved forward-looking perception is a key element in building positive behaviours,

which can provide a future, oriented source of goal directed reinforcement, rather than that

commonly described by sufferers which is firmly anchored in the past. Failed coping is a

self-fulfilling process, the cycle repeats and learning only serves to reinforce the original

view.

This positive trend was also found in responses to question 6.

Q.6 The noise does not make me feel inadequate


Strongly agree 25% 50%

These responses are evidence of an increased capacity to meet the emotional demands

placed upon them by LFN. The more effective individuals strategies for managing the

impact of noise the more likely they are to experience the noise as less intrusive and

annoying. This would support reduced anxiety levels and associated negative mood

states.


One of the most telling aspects of individual’s experience of trying to cope with LFN is the

gradual yet apparently remorseless growth in a disconnection between them and those

that do not have their noise experience.

The post therapy ratings for Q.8 indicate that subjects have reduced concerns about how

their responses to the noise may impact upon their relationships with others. Given the

general trend towards improved coping, this may be taken as evidence that the noise is

less of a concern to the subject and therefore figures less in their lives with others. Again,

this would be a significant development, as many LFN sufferers describe a focus that

frequently dominates, relationships with others.

Results below are again consistent with a trend towards improvement in individuals’ ability

to cope and to move towards improved well-being with 28.6% AFRT compared with 55.5%

AFTN onset.

Q.8 Feelings of Isolation: I think that people are often uncomfortable being around me because of my problem with the noise


Strongly agree 37.5 % 12.5%

Agree 12.5 12.5

Total 50 25

The general trend for post therapy ratings is positive with evidence of improvements in

aspects measuring Quality of Life and Quality of Coping.


8.4 Quality of Life and Coping comparisons before and after relaxation therapy

The five point scale for responses to Quality of Life and Coping questionnaires goes from

strong agreement to strong disagreement. By comparing the scores for each point on the

scale, summed over all the questions before and after therapy, it is possible to investigate

whether the subjects exhibit a shift in their responses. For example, is there a change in

the "strong agreement" with the negativity of their lives?

In Quality of Life, the first 13 questions generally relate to the negative factors of life. The

remainder generally relate to positive factors. So these are considered separately

QofL Q 1 to 13. Negative factors

1 =strongly agree. 2 = agree. 3= neutral. 4= disagree. 5 = strongly disagree.

Before After

Fig 8.4 Quality of Life – negative factors

Fig 8.4 shows a move from agreement with negative aspects to disagreement with these, illustrated by a shift to the right


Quality of Life Q 14 – 27 Positive factors

1 =strongly agree. 2 = agree. 3= neutral. 4= disagree. 5 = strongly disagree. Before After

Fig 8.5 Quality of life - positive factors

Fig 8.5 is not as clear. Overall there is a post-therapy decrease in both strong agreement and strong disagreement and a shift to neutrality, perhaps indicating uncertainty.

Coping . All questions related to negative factors in their lives

1 =strongly agree. 2 = agree. 3= neutral. 4= disagree. 5 = strongly disagree Before After

Fig 8.6 Coping

Here there is a decrease in agreement with negative factors and a trend towards disagreement with these, shown by a shift to the right.

Thus the overall results illustrate a positive trend in both Quality of Life and Coping.


8.5 Physiological parameters after relaxation therapy.The physiological parameters measured in Section 6.7 were repeated at the end of the

relaxation sessions and average responses over the subjects are compared in Figs 8.7

and 8.8, where the stimuli are:

BR – initial base rate. WN – white noise: 70LFN – a 70Hz tone; NBMOD – narrow band

moderate noise 150Hz to 250Hz: LFNNR – low frequency noise of narrow band 50Hz to

200Hz: TARGET – an attempt to match the subject's problem noise.

Fig 8.7 Electrodermal activity before and after relaxation sessions

Fig 8.8 Heart rate before and after relaxation session


0

2

4

6

8

10

12

EDA


Before

After

Before

After

020406080

100120140

Hea

rt ra

te


69

Fig 8.7 shows that the electrodermal activity was generally lower after the relaxation

sessions. Fig 8.8 is less clear. The base rate for after the sessions is biased by one

subject who presented an abnormally high heart rate at the start of the tests. However,

there is reduced average response to the 70Hz noise and to the target noise.

9.0 Comments from Subjects.The limited number of subjects inhibits detailed statistical assessment, but the comments

given at the completion of the six relaxation sessions give a good indication of results on a

personal basis.

9.1 Comments returned with the Low frequency Noise Reaction Questionnaire

The post-relaxation completion of the questionnaire included space for comments on the

project. The following were received.

Subject A – Location on Insights Evaluator, Fig 6.2 Supporter: "I am enjoying the

project and am grateful to have been invited to take part. It is interesting, as well as

comforting to me, to meet others who have been suffering in a similar manner. They, too,

have displayed initiative and great resourcefulness in trying to find the cause, without any

success. My personality profile will confirm to you the anguish I have experienced in

having to fight this battle.

It is extraordinary, in the highly technological age of 2005, that it has proved impossible for

acoustic experts to pinpoint the nuisance so as to pronounce if it is harmful to live with or

not. As the government is financing this project, it is evidently aware of the "nuisance"

caused to so many of us. I do hope your project will help to tackle and put right this

problem.

Donald Robertson's Stressology tape is excellent for general relaxation with a view to

overcoming tension. However, it has been of little use to me when the nuisance is loudly

audible. The tape does not drown out the "rumbling/droning/hum". In fact, sometimes

initially, it seems to accentuate the sound of the nuisance; similarly earplugs on occasion.

………Thank you for your personal consideration to me."


Comment This subject was very focussed on the desire that the noise should be dealt

with and did not appreciate the difficulties in this.

Subject B – Location on Insights Evaluator, Fig 6.2 - Observer: "1. Dr Robertson's "distraction technique" is useful in helping the subject ignore both

imposed and self-generated continuation of the effects of inaudible disturbance.

2. I suspect that it would be more effective if he presented it as an effective way of

avoiding the noise (or noise continuation) rather than claiming it as "removing anxiety".

Not all sufferers have anxiety.

If so presented then the tape alone, or perhaps only one assisted session would be quite

sufficient. There is no improvement from continuing sessions (unless there are benefits

which are not obvious to the subject)

3. The effect has not been particularly marked, but it has provided a new mechanism for

helping me to get to sleep!"

Comment. This subject was rather critical of some approaches, but does appear to have

benefited

Subject C- Location on Insights Evaluator, Fig 6. 2- Reformer "Would like a statutary law written into leases that already "No loud TV etc between 11pm

to 7am, to be increased from 10pm to 8am" and that "severe penalty of removal of

offending equipment and/or £5000 fine" (which I understand is now law). Because most

people don't know this and therefore don't take their antisocial behaviour seriously.

Am in retirement (home for the bewildered) home and they're mostly deaf and have TV

and radio on 24 hours – nod off, and don't know whether it is night or day. And when near

their end, confused and don't care and Manageress says "What can I do" even though

she tells them bothering others (who can still hear) and given them extension earpiece

which is v. easy to use.

PS The noise (endless or orchestrated) paralyses me.

PPS The all night radio – even earplugs don't work or exaggerates it."

Comment. This subject was very stressed at the start of the sessions but appeared to

improve and stated that she had stopped chewing gum and no longer had pains in the


chest and as many headaches. She listened to the relaxation CD on a daily basis and also

at night to help with sleep. However, it was felt that she might easily regress.

Subject D: Location on Insights Evaluator, Fig 6.2 - Inspirer

"There should be more time for the sufferers to talk to each other about their situations.

The most important part of this is that you meet others who admit to hearing noises, you

don't feel so alone."

Comment This subject said that the noise no longer made her cry and that she could now

cope with it except when it reached a peak.

Subject E: Location on Insights Evaluator, Fig 6.2 - Supporter

"The course has been very beneficial. It helps me to meet other sufferers and uplifting to

receive some help with our problems with noise.

The main effect it has had on me is that I no longer feel so victimised. I have been able to

separate the two kinds of stress I have been caught up in. One being my powerful

negative feelings towards the persons making the noise – and the other being the noise

itself. Releasing myself from the stress of anger and resentment re the selfishness of

people has enabled me to concentrate more fully on coping just with the noise. I no longer

feel quite as anxious as to when the noise will begin. I do hope I can maintain this when

summer arrives and the overall noise levels soar.

As well as using the techniques taught, I try to imagine that the ugly noise is a beautiful

one – nature's music - and that is in fact having a healing effect upon me. I hope I can

succeed in this brainwashing myself! I also used to do a lot of visualisation but noise cut

me off from this. I am happy to have now rediscovered this talent and be reconnected to a

greater sense of control. It is odd that since I began this course, there has actually been

less noise (verified by others) and neighbours have begun a campaign to deal with the

troublesome Pub in our street. So I am no longer fighting alone. Yes!!! Whoopee!

Thank you for organising and conducting the course.

As to how it could be improved, that is hard to say as methods would very likely reveal

themselves in time through continuing to run such schemes.


Perhaps greater structure in not spending too much time discussing noise sources and

battles people are having - Concentrating more on the actual techniques and their effects

on us. It is till, however, important that people do have space or the above, so perhaps a

separate meeting would be possible. I suppose we should meet afterwards for coffees

etc, but people do need to get home.

Overall I don't really have any complaints. This is a great thing to be doing and there can

be no doubt at all that as long as people regularly practice the methods, they will gain

benefits – often unexpected as well."

Comment. This subject had had a long experience of low frequency noise and general

environmental noise disturbance and gain clear benefit from the relaxation sessions

Subject F Location on Insights Evaluator, Fig 6. 2 - Supporter

"The project has helped me to identify the fact that the noise does really exist, and by my

trying to ignore it, it won't go away by itself. By not doing enough constructively, this has

caused problems with another family member, who suffers greatly from the effects of this

continuous low frequency noise. They feel I have not been supportive of them enough .

The techniques of the coping mechanisms have helped me be more relaxed in a way to

cope with its effects. Talking face to face with other sufferers also has a beneficial effect.

The methods should be available to all sufferers of this problem and the Government

should be asked to work much more openly with all Environmental Health Agencies, and

also groups from other countries, to seek a solution to the cause of the LFN, and eliminate

it. The cause does have serious effects on the lives of people unfortunate enough to

suffer from it.

To gauge the benefits of this project, the people taking part, should be asked f they would

be willing to be followed up, after about a year, from the end of the sessions (or even 6

months). The Coping Strategy may not work for everyone, but some success rate is better

than none!.

The sharing of experiences is also an important part of the group sessions.

I am not sure at this point how this method can be improved on for future use, but I will

give some thought. All I can say is that it has helped me thus far."


Comment This subject lived with another LFN sufferer who did not attend the sessions.

There appears to be a small cluster of sufferers in her locality

Subject G Location on Insights Evaluator, Fig 6. 2 – Observer

"It has brought into focus the level of anxiety I live with continuously. Achieving a degree of

"positive disinterest" would make a tremendous difference. The brief experiences of this,

listening to the CD, has made this clear.

The temperomandibular disorder approach also I hoped would be pursued, as I have had

alignment and tension in the face. Its inclusion seemed unplanned, regarding time. But I

would value resulting information, suggested treatment etc."

Comment This subject also has problems from general noise, some of which is believed

to be of malicious origin. He has appreciated the importance of detachment from the

problem

Subject H Location on Insights Evaluator, Fig 6. 2 – Coordinator

This subject dropped out after a few sessions , as lack of sleep from the noise had made

him too ill to travel to London.

Subject I Location on Insights Evaluator, Fig 6. 2 – Coordinator

"Relaxation with music. Group meetings of 18 to 20 people."

Comment This subject has been very stressed and believes that the noise is of malicious

origin. The relaxation has helped him to cope with his anxieties.

9.2 Comments returned on the Participants' Evaluation Form.

Question 1. What has been the most helpful technique, concept or aspect of the sessions?

Subject A "It has been interesting and useful to meet others who are suffering the same

problem, and to have the support of Dr Leventhall and Donald Robertson. The latter's CD

Rom on Stressology is a useful exercise in relaxation."

Subject B "Relaxation detachment by a formal mechanism e.g. the CD is worthwhile.

Other techniques probably not.. VKD also useful as a supplementary technique."


Subject C "The tape"

Subject D "Being able to meet others in the same situation"

Subject E "Focussing awareness on the choices one has to assist in coping. Greater

detachment from the noises and from one's own stress reactions: letting go of negative

feelings towards the people making the noise and trying to deal with only the noise.

having "somewhere to go" via the visualisations which gives a sense of power and control.

Sharing the group with fellow sufferers."

Subject F "The Benson Technique is helpful. For me the VKD method seems to help the

most. Interacting with other sufferers in the sessions is both useful and helpful".

Subject I "Learning to relax".

Question 2 How could these workshop sessions be improved or made more helpful?

Subject A "It would be more helpful if my problem could be identified and put right"

Subject B "Perhaps the silence of the repetition gives no benefit (It appears not to have

helped me). I would not stress the possibility to EHO's other than for individuals who have

acute impact on their way of life."

Subject C "None"

Subject D "Maybe a little longer time but with a break in between"

Subject E "Hard to say as this is a new group. I feel that time would create and reveal

the structures that work best. Perhaps the group should meet for two separate purposes –

one to actually focus on the techniques and two to discuss causes effects etc - as I feel

these can tend to overlap."


Subject F "The sessions are satisfactory"

Subject I "Meeting twice a week."

Question 3 What advice would you give to someone who is bothered by Low Frequency Noise?

Subject A "It is difficult as no matter one's efforts to have the source identified one comes

up against a brick wall. I make these observations in the full knowledge that we are all

sensitive to different noises and to varying degrees of disturbing noises."

Subject B "Try to find out the sources 1. of any current noise stimulation 2. of the

source of change in hearing perception."

Subject C "Move"

Subject D "Buy a white noise machine"

Subject E "Try to rise above feelings of victimisation and realise that there are strategies

available to help. Let go of resentment and cultivate detachment. Practise visualisations

and listen to sounds you do enjoy."

Subject F "Firstly discuss with as many people as possible. Report to Environmental

Health Department. Contact LFN Association for help and advice. Try not to let it control

your life."

Subject I "To contact Dr Leventhall at present time."


10 CONCLUSIONSA group of subjects, long term complainants of noise, and in particular low frequency

noise, have been introduced to relaxation therapy as a means of relieving the worst

symptoms consequent on the noise. That is, to lower their responses on the scale shown

in Fig 1.1. Nine subjects commenced the therapy, but one dropped out due to illness, so

that deductions have been based on the same eight subjects for before and after the

relaxation sessions.

Any change in response to subjects' noise problem was obtained from questionnaires

before and after the relaxation sessions and from physiological tests in the presence of a

variety of noises.

There is a clear trend in the overall results to improved Quality of Life and improved

Coping with Life. The number of subjects is insufficient for meaningful statistical

deductions, but a review of the comments of the subjects on changes in their personal

situations (Section 9) showed that, whilst all had some benefit, some had derived

considerable benefit.

Relaxation and its associated techniques have been shown to be a useful means of

reducing the stress caused by noise problems, such as those from some low frequency

noises, for which a technical noise control solution cannot be found


Appendix 1 LFN Reaction Questionnaire.The following questionnaire was completed by the subjects before the start of the relaxation sessions to be returned by post. It was completed again at the end of the sessions with modification to the final three questions

LOW FREQUENCY NOISE QUESTIONNAIRE

Name……………………………………………………..… Date……………….

This questionnaire is part of a Defra project on Coping Strategies for Low Frequency Noise. It is intended to find out what effect the noise is having on you, but not all of the questions may apply to you. Answer each of the questions which does apply to you by ticking that description which best fits how the noise has affected you over the past few weeks

1 The noise has made me worry about it

Not at all A little of the time Some of the time A good deal of the time Most of the time

2 The noise has made me feel tense


3 The noise has made me feel irritable


4 The noise has made me feel angry


5 The noise has made me cry


6 The noise has led me to avoid quiet situations


7 The noise has made me feel less interested in going out


8 The noise has made me feel depressed


9 The noise has made me feel annoyed


10 The noise has made me feel confused


11 The noise "drives me crazy"



12 The noise has interfered with my enjoyment of lifeNot at all A little of the time Some of the time A good deal of the time Most of the time

13 The noise has made it hard for me to concentrateNot at all A little of the time Some of the time A good deal of the time Most of the time

14 The noise has made it hard for me to relaxNot at all A little of the time Some of the time A good deal of the time Most of the time

15 The noise has made me feel distressedNot at all A little of the time Some of the time A good deal of the time Most of the time

16 The noise has made me feel helplessNot at all A little of the time Some of the time A good deal of the time Most of the time

17 The noise has made me feel frustrated with thingsNot at all A little of the time Some of the time A good deal of the time Most of the time

18 The noise has interfered with my ability to workNot at all A little of the time Some of the time A good deal of the time Most of the time

19 The noise has led me to despairNot at all A little of the time Some of the time A good deal of the time Most of the time

20 The noise has led me to avoid noisy situationsNot at all A little of the time Some of the time A good deal of the time Most of the time

21 The noise has led me to avoid social situationsNot at all A little of the time Some of the time A good deal of the time Most of the time

22 The noise has made me feel helpless about the futureNot at all A little of the time Some of the time A good deal of the time Most of the time

23 The noise has interfered with my sleepNot at all A little of the time Some of the time A good deal of the time Most of the time

24 The noise has led me to think about suicideNot at all A little of the time Some of the time A good deal of the time Most of the time

25 The noise has made me feel panicky


26 The noise has made me feel tormentedNot at all A little of the time Some of the time A good deal of the time Most of the time


27 The noise has forced me out of my homeNot at all A little of the time Some of the time A good deal of the time Most of the time

Please write a few words in response to the following questions. Use a separate sheet if necessary

28. Do you believe that you know the source of the noise?

29. Have you tried to have it reduced, and with what result?

30. Give any other comments which you wish.

And finally, are you taking prescription drugs? Some of the standard prescription drugs may have side effects on hearing. If you are taking any, could you have a look at the pack and write the name below.

Analysis of the Questionnaire

The results of the questionnaire were scored according to

Not at all = 0

A little of the time = 1

Some of the time = 2

A good deal of the time = 3

Most of the time = 4

A question not answered was given a "blank" score. A summary of the Questionnaire results is given in Table 3 and have been discussed earlier in Section 7 for the subjects before start


Subject A A B B C C D D E E F F G G H H I I Totals PercentQ.No Start Finish S F S F S F S F S F S F S F S F S F S F1 0 4 3 3 4 4 4 4 3 2 3 2 2 2 2 3 4 24 25 67 782 4 3 0 2 4 1 4 3 3 2 2 2 1 3 3 3 3 24 19 67 593 3 2 2 0 4 2 3 3 2 2 2 1 1 2 2 2 2 21 14 58 444 4 2 0 0 4 3 3 4 2 1 2 1 2 2 - 3 2 20 15 56 475 2 2 0 0 2 2 3 2 2 1 1 1 0 1 - 0 0 10 8 28 256 0 0 0 0 - 0 - 0 0 0 0 0 3 3 - 0 0 3 3 8 97 0 0 0 0 4 3 - 0 3 1 3 1 0 3 2 2 3 14 11 39 34 8 3 1 0 1 4 3 3 2 2 2 2 2 1 3 2 2 2 19 16 58 509 3 2 3 1 4 3 3 3 2 1 2 1 2 2 - 3 1 22 14 61 4410 0 1 0 0 - 0 2 3 0 0 2 1 0 1 2 0 0 6 6 17 1911 3 4 - 0 4 2 4 3 2 1 1 0 0 0 - 2 0 16 10 44 3112 3 3 3 3 4 3 4 3 3 1 3 1 3 2 2 3 3 28 19 78 5913 2 3 3 2 4 2 3 3 2 2 2 1 2 3 3 3 3 24 19 67 5914 4 3 3 2 4 2 4 3 3 2 3 2 2 3 3 2 3 28 20 78 6215 4 1 1 1 4 3 4 3 1 1 2 1 0 2 2 2 2 20 14 56 4416 3 4 2 0 4 3 4 3 2 1 1 1 3 2 - 2 3 21 17 58 5317 0 4 3 2 4 3 3 3 2 2 1 1 2 2 3 2 1 20 18 56 5618 2 4 3 3 4 3 3 2 2 1 1 1 2 3 3 3 2 23 19 64 5919 3 2 0 0 4 4 3 2 2 1 1 1 0 1 - 1 1 14 12 39 3820 3 3 0 0 4 3 3 3 4 3 3 2 4 4 - 0 3 21 21 58 6721 1 1 0 0 4 3 3 3 3 0 2 1 0 4 3 - 3 16 15 44 4722 4 2 1 1 4 3 3 3 2 1 1 1 1 2 - 2 3 18 16 50 5023 3 3 4 3 4 4 4 4 3 3 3 2 2 1 4 3 3 30 23 83 7224 0 1 1 0 4 2 2 2 1 0 1 0 1 1 - 0 0 10 6 28 1925 0 0 0 0 4 0 3 2 0 0 3 2 0 0 1 0 0 11 4 31 1326 0 1 4 1 4 3 4 4 2 2 0 0 3 2 - 2 1 19 14 53 4427 2 2 2 2 4 0 4 4 1 2 1 1 0 3 2 0 0 16 14 44 44Totals 56 58 38 27 98 64 83 74 54 35 48 30 37 56 39 45 48 - -Percent 52 54 35

(36)25 91

(98)59 77

(83)68 50 32 44 28 34 52 36

(61)-- 42

(43)44 - -

Table 3 LFN Questionnaire results. (Percentages in brackets are out of the total answered)S is for the Start of project, F for the Finish


Appendix 2 Quality of Life with Noise. Full results

Quality of Life Questionnaire (Current) Scores

I have a lack of energy

Frequency Percent Valid PercentCumulative

PercentValid strongly

agree 1 12.5 12.5 12.5

agree 3 37.5 37.5 50.0neutral 2 25.0 25.0 75.0disagree 1 12.5 12.5 87.5strongly disagree 1 12.5 12.5 100.0

Total 8 100.0 100.0

I have nausea



agree 1 12.5 12.5 12.5

neutral 3 37.5 37.5 50.0disagree 1 12.5 12.5 62.5strongly disagree 3 37.5 37.5 100.0

Total 8 100.0 100.0

Because of my fatigue I have trouble meeting the needs of my family



agree 1 12.5 12.5 12.5

agree 2 25.0 25.0 37.5neutral 4 50.0 50.0 87.5strongly disagree 1 12.5 12.5 100.0

Total 8 100.0 100.0

I experience bad headaches



agree 1 12.5 12.5 12.5


Total 8 100.0 100.0

I am bothered by side effects of treatment




agree 3 37.5 37.5 37.5

agree 2 25.0 25.0 62.5disagree 2 25.0 25.0 87.5strongly disagree 1 12.5 12.5 100.0

Total 8 100.0 100.0

I feel ill



agree 2 25.0 25.0 25.0


Total 8 100.0 100.0

I am forced to spend time in bed



agree 1 12.5 12.5 12.5


Total 8 100.0 100.0

I feel sad



agree 1 12.5 12.5 12.5


Total 8 100.0 100.0


I am dissatisfied with how I am coping with the noise



agree 1 12.5 12.5 12.5


Total 8 100.0 100.0

I am losing hope in the fight against noise



agree 3 37.5 37.5 37.5


Total 8 100.0 100.0

I feel anxious



agree 4 50.0 50.0 50.0

agree 1 12.5 12.5 62.5neutral 2 25.0 25.0 87.5disagree 1 12.5 12.5 100.0Total 8 100.0 100.0

I worry about the noise



agree 4 50.0 50.0 50.0


I worry that my condition will get worse



agree 4 50.0 50.0 50.0

neutral 2 25.0 25.0 75.0disagree 2 25.0 25.0 100.0Total 8 100.0 100.0


I feel close to my friends



agree 3 37.5 37.5 37.5


Total 8 100.0 100.0

I get emotional support from my family



agree 3 37.5 37.5 37.5

agree 2 25.0 25.0 62.5disagree 3 37.5 37.5 100.0Total 8 100.0 100.0

I get support from my friends



agree 3 37.5 37.5 37.5


My family has accepted that I have a problem with noise



agree 3 37.5 37.5 37.5


I am satisfied with family communication about the noise problem


PercentValid strongly 4 50.0 50.0 50.0


agreeneutral 2 25.0 25.0 75.0disagree 1 12.5 12.5 87.5strongly disagree 1 12.5 12.5 100.0

Total 8 100.0 100.0

I feel close to my partner (or the person who is my main support)



agree 5 62.5 62.5 62.5


Total 8 100.0 100.0

Communicating about the noise is very difficult



agree 1 12.5 12.5 12.5


Total 8 100.0 100.0

I am able to concentrate at home



agree 1 12.5 12.5 12.5


Total 8 100.0 100.0

My work at home is fulfilling



agree 1 12.5 12.5 12.5

agree 2 25.0 25.0 37.5neutral 2 25.0 25.0 62.5disagree 1 12.5 12.5 75.0strongly 2 25.0 25.0 100.0


disagreeTotal 8 100.0 100.0

I am able to enjoy life



agree 1 12.5 12.5 12.5


Total 8 100.0 100.0

I have accepted the noise


PercentValid agree 1 12.5 12.5 12.5


Total 8 100.0 100.0

I am sleeping well



agree 1 12.5 12.5 12.5


Total 8 100.0 100.0

I am enjoying the things I usually do for fun


PercentValid agree 1 12.5 12.5 12.5


Total 8 100.0 100.0

I am content with the quality of my life right now



PercentValid neutral 1 12.5 12.5 12.5

disagree 3 37.5 37.5 50.0strongly disagree 4 50.0 50.0 100.0

Total 8 100.0 100.0

Appendix 3 Quality of COPING Questionnaire: Current with Noise:

I have a hard time adjusting to the noise



agree 5 62.5 62.5 62.5

neutral 1 12.5 12.5 75.0disagree 2 25.0 25.0 100.0Total 8 100.0 100.0

Because of the noise, I miss the things I like to do most



agree 2 25.0 25.0 25.0


The noise makes me feel useless at times



agree 2 25.0 25.0 25.0


The noise has made me more dependent on others than I want to be




agree 2 25.0 25.0 25.0


Total 8 100.0 100.0

The noise has made me a burden on my family and friends



agree 2 25.0 25.0 25.0


Total 8 100.0 100.0

The noise does not make me feel inadequate



agree 1 12.5 12.5 12.5


Total 8 100.0 100.0

I will never cope with the noise well enough to make me happy



agree 1 12.5 12.5 12.5


I think that people are often uncomfortable being around me because of my problem with the noise


PercentValid strongly 3 37.5 37.5 37.5


agreeagree 1 12.5 12.5 50.0neutral 1 12.5 12.5 62.5disagree 1 12.5 12.5 75.0strongly disagree 2 25.0 25.0 100.0

Total 8 100.0 100.0

APPENDIX 4 Quality of Life Questionnaire Before LF Noise.





Total 8 100.0 100.0

I have nausea


PercentValid disagree 2 25.0 25.0 25.0

strongly disagree 6 75.0 75.0 100.0

Total 8 100.0 100.0





Total 8 100.0 100.0





Total 8 100.0 100.0



Percent


Valid neutral 1 12.5 16.7 16.7strongly disagree 5 62.5 83.3 100.0

Total 6 75.0 100.0Missing 999 2 25.0Total 8 100.0

I feel ill




Total 8 100.0 100.0




disagree 8 100.0 100.0 100.0

I feel sad




Total 8 100.0 100.0



PercentValid strongly agree 3 37.5 75.0 75.0





Percent


Valid strongly agree 1 12.5 25.0 25.0neutral 1 12.5 25.0 50.0disagree 1 12.5 25.0 75.0strongly disagree 1 12.5 25.0 100.0


I feel anxious



agree 2 25.0 25.0 25.0


Total 8 100.0 100.0















agree 4 50.0 50.0 50.0





agree 2 25.0 28.6 28.6






agree 2 25.0 28.6 28.6

agree 2 25.0 28.6 57.1neutral 3 37.5 42.9 100.0Total 7 87.5 100.0

Missing 999 1 12.5Total 8 100.0










agree 3 37.5 75.0 75.0

agree 1 12.5 25.0 100.0Total 4 50.0 100.0

Missing 999 4 50.0Total 8 100.0




agree 4 50.0 66.7 66.7


Missing 999 2 25.0Total 8 100.0

Communicating about the noise is very difficult



neutral 2 25.0 50.0 75.0strongly disagree 1 12.5 25.0 100.0





agree 4 50.0 50.0 50.0


Total 8 100.0 100.0




agree 3 37.5 37.5 37.5

agree 3 37.5 37.5 75.0disagree 1 12.5 12.5 87.5strongly disagree 1 12.5 12.5 100.0

Total 8 100.0 100.0





agree 3 37.5 37.5 37.5


Total 8 100.0 100.0






I am sleeping well



agree 3 37.5 37.5 37.5


Total 8 100.0 100.0




agree 2 25.0 25.0 25.0





agree 2 25.0 25.0 25.0

agree 4 50.0 50.0 75.0strongly disagree 2 25.0 25.0 100.0

Total 8 100.0 100.0


Appendix 5 Quality of Life After Relaxation Therapy


2 25.0 25.0 25.02 25.0 25.0 50.02 25.0 25.0 75.02 25.0 25.0 100.08 100.0 100.0

strongly agreeagreeneutraldisagreeTotal

ValidFrequency Percent Valid Percent

CumulativePercent

I have nausea

1 12.5 12.5 12.52 25.0 25.0 37.51 12.5 12.5 50.04 50.0 50.0 100.08 100.0 100.0

agreeneutraldisagreestrongly disagreeTotal


CumulativePercent


2 25.0 25.0 25.02 25.0 25.0 50.02 25.0 25.0 75.02 25.0 25.0 100.08 100.0 100.0



CumulativePercent


2 25.0 25.0 25.04 50.0 50.0 75.01 12.5 12.5 87.51 12.5 12.5 100.08 100.0 100.0



CumulativePercent


1 12.5 12.5 12.51 12.5 12.5 25.02 25.0 25.0 50.01 12.5 12.5 62.53 37.5 37.5 100.08 100.0 100.0

strongly agreeagreeneutraldisagreestrongly disagreeTotal


CumulativePercent



1 12.5 14.3 14.31 12.5 14.3 28.62 25.0 28.6 57.11 12.5 14.3 71.42 25.0 28.6 100.07 87.5 100.01 12.58 100.0


Valid

999MissingTotal


Percent

I feel ill

1 12.5 12.5 12.53 37.5 37.5 50.03 37.5 37.5 87.51 12.5 12.5 100.08 100.0 100.0

strongly agreeneutraldisagreestrongly disagreeTotal


CumulativePercent


2 25.0 25.0 25.02 25.0 25.0 50.04 50.0 50.0 100.08 100.0 100.0

neutraldisagreestrongly disagreeTotal


CumulativePercent

I feel sad

1 12.5 12.5 12.54 50.0 50.0 62.53 37.5 37.5 100.08 100.0 100.0

agreeneutraldisagreeTotal


CumulativePercent


4 50.0 50.0 50.01 12.5 12.5 62.52 25.0 25.0 87.51 12.5 12.5 100.08 100.0 100.0



CumulativePercent



2 25.0 25.0 25.01 12.5 12.5 37.51 12.5 12.5 50.03 37.5 37.5 87.51 12.5 12.5 100.08 100.0 100.0



CumulativePercent

I feel anxious

2 25.0 25.0 25.03 37.5 37.5 62.52 25.0 25.0 87.51 12.5 12.5 100.08 100.0 100.0



CumulativePercent


1 12.5 12.5 12.52 25.0 25.0 37.53 37.5 37.5 75.02 25.0 25.0 100.08 100.0 100.0



CumulativePercent


1 12.5 12.5 12.53 37.5 37.5 50.04 50.0 50.0 100.08 100.0 100.0

strongly agreeneutraldisagreeTotal


CumulativePercent


1 12.5 12.5 12.53 37.5 37.5 50.03 37.5 37.5 87.51 12.5 12.5 100.08 100.0 100.0



CumulativePercent



1 12.5 14.3 14.32 25.0 28.6 42.93 37.5 42.9 85.71 12.5 14.3 100.07 87.5 100.01 12.58 100.0


Valid

999MissingTotal


Percent


1 12.5 12.5 12.52 25.0 25.0 37.55 62.5 62.5 100.08 100.0 100.0

strongly agreeagreeneutralTotal


CumulativePercent


4 50.0 50.0 50.03 37.5 37.5 87.51 12.5 12.5 100.08 100.0 100.0

strongly agreeneutraldisagreeTotal


CumulativePercent


3 37.5 37.5 37.52 25.0 25.0 62.53 37.5 37.5 100.08 100.0 100.0

strongly agreeagreeneutralTotal


CumulativePercent


3 37.5 42.9 42.91 12.5 14.3 57.11 12.5 14.3 71.42 25.0 28.6 100.07 87.5 100.01 12.58 100.0


Valid

SystemMissingTotal


Percent


Communicating abouth the noise is very difficult

2 25.0 25.0 25.01 12.5 12.5 37.51 12.5 12.5 50.03 37.5 37.5 87.51 12.5 12.5 100.08 100.0 100.0



CumulativePercent


2 25.0 25.0 25.01 12.5 12.5 37.52 25.0 25.0 62.53 37.5 37.5 100.08 100.0 100.0



CumulativePercent


1 12.5 12.5 12.52 25.0 25.0 37.53 37.5 37.5 75.02 25.0 25.0 100.08 100.0 100.0



CumulativePercent


2 25.0 25.0 25.03 37.5 37.5 62.51 12.5 12.5 75.02 25.0 25.0 100.08 100.0 100.0



CumulativePercent


3 37.5 37.5 37.53 37.5 37.5 75.02 25.0 25.0 100.08 100.0 100.0



CumulativePercent


I am sleeping well

1 12.5 12.5 12.51 12.5 12.5 25.02 25.0 25.0 50.02 25.0 25.0 75.02 25.0 25.0 100.08 100.0 100.0



CumulativePercent


4 50.0 50.0 50.01 12.5 12.5 62.51 12.5 12.5 75.02 25.0 25.0 100.08 100.0 100.0



CumulativePercent


4 50.0 50.0 50.02 25.0 25.0 75.02 25.0 25.0 100.08 100.0 100.0



CumulativePercent

APPENDIX 6 QUALITY OF COPING (AFTER RELAXATION THERAPY)


I have a hard time adjusting to the noise

2 25.0 25.0 25.03 37.5 37.5 62.52 25.0 25.0 87.51 12.5 12.5 100.08 100.0 100.0



CumulativePercent

Becasue of the noise, I miss the things I like to do most

1 12.5 12.5 12.55 62.5 62.5 75.01 12.5 12.5 87.51 12.5 12.5 100.08 100.0 100.0



CumulativePercent

The noise makes me feel useless at times

1 12.5 12.5 12.52 25.0 25.0 37.51 12.5 12.5 50.02 25.0 25.0 75.02 25.0 25.0 100.08 100.0 100.0



CumulativePercent

The noise has made me more dependent on others than I want to be

2 25.0 25.0 25.02 25.0 25.0 50.01 12.5 12.5 62.53 37.5 37.5 100.08 100.0 100.0



CumulativePercent

The noise has made me a burden on my family and friends

1 12.5 12.5 12.51 12.5 12.5 25.03 37.5 37.5 62.51 12.5 12.5 75.02 25.0 25.0 100.08 100.0 100.0



CumulativePercent


Because of the noise, I miss the things I like to do most

102


1 12.5 12.5 12.53 37.5 37.5 50.03 37.5 37.5 87.51 12.5 12.5 100.08 100.0 100.0

strongly agreeagreeneutralstrongly disagreeTotal


CumulativePercent


1 12.5 12.5 12.53 37.5 37.5 50.03 37.5 37.5 87.51 12.5 12.5 100.08 100.0 100.0

strongly agreeagreeneutralstrongly disagreeTotal


CumulativePercent

I will never cope with the noise well enough to make me happy

1 12.5 12.5 12.54 50.0 50.0 62.53 37.5 37.5 100.08 100.0 100.0

strongly agreedisagreestrongly disagreeTotal


CumulativePercent

I think that people are often uncomfortable being around me becasue of myproblem with the noise

1 12.5 12.5 12.51 12.5 12.5 25.03 37.5 37.5 62.53 37.5 37.5 100.08 100.0 100.0



CumulativePercent


Appendix 7 The Jungian Model for Individual Differences

Summary of the Characteristics Associated with the Jungian Model of Individual Differences (See: http://www.cognitiveprocesses.com for further information)

INFORMATION-ACCESSING PROCESSES—PerceptionInformation Accessing Processes - Perception

Extraverted Sensing. Experiencing the immediate context; taking action in the physical world; noticing changes and opportunities for action; accumulating experiences; scanning for visible reactions and relevant data; recognizing “what is.” Noticing what was available.

Introverted Sensing. Reviewing past experiences; “what is” evoking “what was”; seeking detailed information and links to what is known; recalling stored impressions; accumulating data; recognizing the way things have always been.

Extraverted Intuiting: Interpreting situations and relationships; picking up meanings and interconnections; being drawn to change “what is” for “what could possibly be”; noticing what is not said and threads of meaning emerging across multiple contexts.

Introverted Intuiting: Foreseeing implications and likely effects without external data; realizing “what will be”; conceptualising new ways of seeing things; envisioning transformations; getting an image of profound meaning or far-reaching symbols.

Organising Evaluating Processes – Judgement

Extraverted thinking: Segmenting; organizing for efficiency; systematizing; applying logic; structuring; checking for consequences; monitoring for standards or specifications being met; setting boundaries, guidelines, and parameters; deciding if something is working or not.

Introverted thinking: Analysing; categorizing; evaluating according to principles and whether something fits the framework or model; figuring out the principles on which something works; checking for inconsistencies; clarifying definitions to get more precision.

Extraverted feeling: Connecting; considering others and the group—organizing to meet their needs and honour their values and feelings; maintaining societal, organizational, or group values; adjusting to and accommodating others; deciding if something is appropriate or acceptable to others

Introverted feeling: Valuing; considering importance and worth; reviewing for incongruity; evaluating something based on the truths on which it is based; clarifying values to achieve accord; deciding if something is of significance and worth standing up for


References


Documents

Christmas gifts 2004 - Defra, UKrandd.defra.gov.uk/Document.aspx?Document=NO01059_3185_FRP.doc · Web viewThat is, a sound, word, phrase, or prayer repeated silently or aloud,