Tinnitus
Tinnitus is a ringing, whistling, clicking, or buzzing-type noise in one or both of your ears. The noise is not caused by an external sound, other people cannot hear it, and it may be constant or come and go. Tinnitus is common and affects about 15 to 20% of people. It usually is associated with an underlying condition such as an ear injury or age-related hearing loss. The pitch and volume of tinnitus varies and, at times, may be so loud that it interferes with the ability to concentrate or hear external sounds. Anyone can experience tinnitus, and certain factors increase the risk of developing are:
Loud noise exposure: Working with heavy machinery, firearms, constant exposure to music played at a high volume, etc.
Age: As age increases, risk increases
Sex: Men are more likely to experience tinnitus
Tobacco and Alcohol use: Smoking and drinking may increase risk
Certain health conditions: Cardiovascular conditions, high blood pressure, history of head injury, etc.
Tinnitus affects people differently and can greatly impact quality of life. It can also be associated with other problems such as stress, fatigue, sleep difficulty, trouble concentrating, headaches, and mood concerns (e.g., irritability, anxiety, depression).
Cognitive Behavior Therapy for Tinnitus
Cognitive behavior therapy (CBT) for tinnitus is an effective, evidence-based treatment that utilizes more traditional CBT techniques as well as techniques from Acceptance and Commitment Therapy (ACT) and Mindfulness Based Cognitive Therapy (MBCT). The aim of therapy is to provide skills to help you cope with tinnitus, decrease distress, and increase overall well-being.
CBT focuses on the relationship between thoughts, feelings, and behaviors, and how changing unhelpful thoughts and behaviors can improve mood and well-being. For example, having the thought, “I can’t live like this” may lead to feelings of sadness and anger, which may lead to withdrawing from loved ones and avoiding pleasant activities, which lowers quality of life. Therapy involves identifying unhelpful thoughts and behaviors and learning tools to change them so you are not caught in a cycle of distress. Specific coping strategies that may be utilized in therapy include:
Identifying automatic and unhelpful thoughts that fuel your distress. What you think affects how you feel. Learning to identify, and challenge, unhelpful thoughts, and create more balanced and helpful thoughts can decrease distress. Additionally, learning to notice and observe thoughts, while letting them come and go, can create a helpful sense of mental distance from thoughts that allows you to be less caught up in them. This skill is called cognitive defusion.
Relaxation exercises. Many people find that stress and physical tension makes tinnitus worse. Relaxation exercises reduce stress and tension which can reduce the intensity of tinnitus. Examples of relaxation exercises are deep breathing and imagery (i.e., imagining a calming and peaceful place). These exercises slow down the nervous system, create a sense of calm and relaxation, help to shift focus away from tinnitus, and may help you to think more clearly and function better.
Pleasant activity scheduling. What you do affects how you feel, and engaging in activities you enjoy boosts mood. When distressed, it is common to push these types of activities to the side, yet, they can provide increased socialization, positive feelings, and a helpful distraction from tinnitus.
Mindfulness skills can help you learn how to nonjudgmentally tune into the present moment (vs. being focused on tinnitus), while acknowledging, and accepting, your thoughts, feelings, and physical sensations. Mindfulness exercises also help you deliberately choose where to put your attention vs. automatically placing all your attention on tinnitus. Examples of exercises include mindful breathing and body scan meditation.
Acceptance-based skills allow you to practice allowing tinnitus to be present without struggling to control, change, or avoid it. This is also called willingness. It is common to want to get rid of tinnitus, yet, this approach typically intensifies it and leads to increased frustration. Developing acceptance does not mean liking tinnitus. The goal is learning to respond to tinnitus in a way that does not fuel irritation.
Values-based action. Thinking about your personal values (i.e., what is meaningful and important to you in life), setting goals, and taking action that aligns with your values can decrease the impact of tinnitus, enhance sense of meaning, and improve your quality of life.
While tinnitus cannot currently be cured, it is possible to change how you respond to tinnitus, which can lower distress and increase a sense of calm and well-being. The above skills center on coping with tinnitus in flexible and helpful ways in order to have a more satisfying life even with tinnitus.
CBT for tinnitus is a time-limited, results-based approach to therapy that aims to provide you with tools to improve your quality of life.
