Clinical Practice, Technology

Hearing more with less cognitive effort – worth a change in behavior

With a little guidance from hearing care professionals on how to make Roger™ use a habit, those with hearing loss can fully reap the rewards of improved attentional load and not miss life’s ‘invisible gorillas’.

“Hey Mom, you saw the Gorilla, right?”

“Huh? Gorilla?” I asked my son. “I am not sure I counted all of the passes, but I did not see a gorilla in that basketball game.”

We were discussing this video clip below from 1999, where you are instructed to count how many times a basketball is passed between players. The task seems easy enough and one would expect most people would notice if a gorilla walked into the game. In actuality, over fifty percent of viewers completely miss the costumed student’s stroll into the match.

Pithecophobia, a fear of apes, or even lack of attention of the average YouTube viewer isn’t to blame. It’s actually a funny quirk of the human brain. Failing to notice the gorilla sauntering into the contest is, in reality, the normal response. The Invisible Gorilla Test from researchers Daniel Simons and Christopher Chabris demonstrates the phenomenon of inattentional blindness. This phenomenon suggests when we focus on one thing, we may not notice when unexpected events occur and we are completely unaware of when we miss those unexpected events.

Attention is a limited resource

It didn’t take researchers long to realize that this ‘blindness’ extended across other modalities of perception. Research by Macdonald and Lavie established that high visual load leads to inattentional deafness, where participants consistently failed to hear the presence of an audible tone in situations of heavy visual information.

The original concept can be traced back to Daniel Kahneman, who suggested that attention is a ‘limited resource’ and we have only a finite amount of this cognitive energy to distribute efficiently between various mental operations. When performing two tasks simultaneously, if one (e.g. the primary task) becomes more taxing, this will result in a decrease in performance of the other (secondary) task.

The Invisible Gorilla Test sticks in my memory for another reason. For me, it demonstrates what it is like to listen with hearing loss.

Specifically, how during episodes of prolonged listening, my attention narrows to only those sounds I am focused on, especially in the presence of ambient noise or reverberation. Intently focusing on the speaker of interest becomes my primary task, all else takes a back seat.

What is important to note is what gets left by the wayside. This can include comments from others who are not in full view, gestures and other forms of non-verbal communication, beeps telling me that my batteries are running low, or remembering that I can change programs to optimize my hearing experience. These are my invisible gorillas, they are things that seem so obvious but I consistently miss them because my attention is focused on a signal.

It can be frustrating when someone asks, “how could you miss that?” or “didn’t you see how he …?,” because most people are unaware how limited their own attention is, and naturally attributed my missing an event with my hearing loss. I would venture to say that it’s not so much the hearing loss, but rather the laser focus the hard of hearing develop to compensate for their hearing loss. We are counting the passes and we miss the gorillas.

I know I can’t fight inattentional blindness (or deafness) because it is a normal limitation to human perception, no matter how well my hearing aids and cochlear implant are fit. Instead, I have come to terms with my humanness and try to be aware of situations where invisible gorillas might saunter in.

Help from the unexpected

When a project manager asked me to try the Phonak Roger Select during its development, the prototype became my constant companion. It became a strategy to reduce cognitive load when listening, one source of my invisible gorilla dilemma. The necessity to hyper-focus my attention receded and I was able to listen longer in meetings and conversations, especially when in ambient noise and reverberation (the bane of ski slope hearing loss). I could catch more information thanks to its MultiBeam Technology. But there is a caveat, It took some conscious effort and help from my friends and family to bring about the behavioral changes needed to obtain benefit from the system.

The greatest challenge I had was remembering to use the remote microphone. I am post-lingually deafened, meaning I did not go through my formative years with FM technology. Remembering to charge, pack, and connect the microphone to my HA and CI did not come naturally. As mentioned above, a couple of those invisible gorillas are about becoming aware of situations when device changes could benefit me.

I needed to change my behavior, but how?  The book The Power of Habit by Charles Dunhigg provided me with a clue; to instigate a change in behavior, develop the new behavior into a habit. To make something a habit, Dunhigg suggests the following formula: find a cue to trigger a routine that provides a reward.

It took a bit of trial and error but I finally found a way to trigger the behavioral change I desired. I carry an orderly little bag around with a Roger Select, two Table Mics II, cables for connectivity, and extra hearing aid and CI batteries (sometimes I slip a snack in too, but that’s irrelevant). No, I haven’t taken the KonMari method too far, this little bag is actually my visual cue to remind me what devices I have at my disposal. My friends and I, through trial and error, have created a routine to setting up my devices. This includes, looking at my conversation partners, the acoustical environment, evaluating where to place the microphones to catch as many voices as I can, and determining if the Roger Select is needed for a specific speaker. The reward is given; I can hear more of what is said and better understand conversations.

My little bag was my solution to changing my behavior, everyone is different and, in my humble opinion, the  key is finding a way to nurture the behavioral changes that need to occur within the user to make any device a successful part of their rehabilitation.This is where I find friends, and family to be key, with the support of an audiologist versed in Roger technologies. In the beginning friends and family provided support by role playing situations with me so I could explore what configurations felt comfortable. They offered suggestions and solutions that were not always apparent; pointing out the gorillas lurking in my blind spots before I took the devices out into the real world.

Honestly, using a Roger system as an adult did not come naturally. Taking a microphone out and placing it on a meeting table, hanging it on the neck of a conversation partner or colleague, or even asking a stranger to speak into the device can be daunting. It lays bare the fact that I have hearing loss. And let’s be frank, people with hearing loss don’t like to categorize themselves as being disabled or having a disability. A part of the reason why hearing loss remains a hidden disability.

My advice to HCPs

I recommend that you stress to those new to using Roger that building the habit of regularly using the device or devices does not come overnight. It takes practice and behavioral adjustments, as well as auditory adjustments to find the situations where Roger brings the most benefit.

Assure them that the reward of improved understanding takes time, patience and persistence, and there will always be invisible gorillas lurking about. By accepting that one’s attentional load is a precious resource that deserves conservation, they can focus on the reward of understanding and take the Roger microphone out of their bag.

 

Acknowledgement:

Thank you to my colleague and friend Jacqueline Drexler for her input and giving me new direction with this article. I invite you to read her insights as a hearing technology user in her previous blog posts.

References

Chabris, C.; Simon, D. (2010) Gorilla Experiment. http://www.theinvisiblegorilla.com/gorilla_experiment.html

Macdonald, J.S., & Lavie, N. (2011). Visual perceptual load induces inattentional deafness. Attention, perception & psychophysics, 73(6), 1780-9.

Kahneman, D. (2011). Thinking, fast and slow. New York, NY, US: Farrar, Straus and Giroux, p. 23.

Duhigg, Charles. The Power Of Habit: Why We Do What We Do In Life And Business. New York : Random House, 2012. Print.

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