cbt self help tips for tinnitus distress

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Tinnitus distress is an emotional condition that can be sufficiently painful and disabling to warrant professional attention. However, the health professionals most consulted for tinnitus—ENTs and Audiologists—are not trained to help with the emotional side of tinnitus. CBT for tinnitus was developed by psychologists who specialize in treating emotional aspects of stress and trauma. If you are struggling with acute tinnitus distress, these CBT self-help guidelines can help. It may also help to read CBT for Tinnitus Skills page, for more detailed descriptions of Careful Thinking, Mindfulness, Valued Activation, Relaxation and Therapeutic Sound. And check out our Resources page, for fact sheets, guided exercises, our CBT for Tinnitus Blog, self-help books, and organizations. 

Practice Pro-Recovery Thinking 

Gloom and doom thinking is part of a normal emotional reaction to stressors like tinnitus, but indulging it only makes things worse. You can’t prevent spontaneous negative thoughts from arising, but you can change how you respond to negative thoughts, by devaluing them, nipping them in the bud, and in their place, practicing pro-recovery thinking:

Reassure Yourself With Facts About Tinnitus and Habituation. As hard as it may be to believe, there really is a strong chance you will pass through this emotional adjustment and arrive at a place where you are no longer bothered by your tinnitus. Fact sheets are available on my Resources page. 

Decatastrophize Tinnitus. Negative thinking fans the flames of distress and slows recovery. If your thoughts are worsening your reaction to tinnitus, you'd better be very certain these thoughts are valid and reasonable. Based on the facts, how likely is it that your worst fears will become reality? For example, you may be convinced that your tinnitus will continue to get louder, that you will lose your hearing, never adapt to tinnitus or recover from tinnitus distress? Based on the actual facts, what are some more reasonable expectations to guide your recovery?

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Learn the Stages of Habituation. Adapting to tinnitus is a gradual process that occurs over weeks, months, even years. Anticipating quick results is ultimately demoralizing and leads to setbacks in recovery. To know what to expect, review Richard Hallam's stages of habituation available on my Resources page.

Read Success Stories written by others who have already habituated to their tinnitus.

Avoid Stories of Those Still Trapped With Tinnitus. In fact, during recovery, it may be helpful to avoid internet forums and medical information sites entirely.

Make a Gratitude List to offset self-pity. A gratitude list is used to remind you of what's valuable in your life, the things you'll commit to reconnecting with over your recovery, the things you'll be fighting for! Review this list often. 

Accept What You Can't Change and Change What You Can. Stop banging your head against the immovable wall of tinnitus. Allow tinnitus to do what it does. Meanwhile, there's a lot that you can do, that you can change, like how you think and act in response to tinnitus. Getting control over that can set you on the course for recovery.

Write a Recovery Statement and Review it Often. A recovery statement is a brief note to yourself used to motivate and sustain your commitment to recovery. Your recovery statement will consist of facts, gratitude items, reminders of past difficulties you’ve handled, what you'll be fighting for, and any other grounding, encouraging words to yourself. Keep your statement with you and review it often. Sample Recovery Statements are available on my Resources page.  

Prepare for Setbacks. Habituation is rarely a smooth road. It occurs in fits and starts and setbacks are common. As soon as you feel that you are out of the woods, something will occur to re-trigger your distress. Expect setbacks and you will be better able to handle them when they occur. 


Practice Self Compassion

Being trapped with tinnitus is genuinely upsetting, even disabling. Be gentle and patient with yourself through this difficult period. If you believe you may have caused the problem, join the club! Kicking yourself now won’t change your tinnitus, but it will make your recovery a lot harder. Time to let go and move on (acceptance).


Stop Searching for a Cure

If there were a cure for tinnitus, everyone would know about it. Your ENT (Otolaryngologist) would have recommended it. This is the most difficult fact for people with tinnitus distress to accept: at present, tinnitus is not a treatable condition. By placing tinnitus in a position of ultimate importance, searching for a cure delays habituation. It makes you poorer and breaks your heart when it doesn’t work!


Get Out of Your Ears and Into Your Life  

Fight the urge to avoid, escape, and generally drop out of life. Whenever possible, choose to engage. Don’t be sidelined by irrational concerns about noise levels. Learn about safe listening and use hearing protection as needed. Slip a copy of your recovery statement into your pocket and start living! 


Stay in the Moment  

The pain of tinnitus distress is increased by dwelling on past regrets and future worries. Practice maintaining a sober focus on the present moment, even if it's not how you want it. Keep your focus on what you can do right now to let go of tinnitus and rejoin your life. Guided mindfulness instruction is available on my Resources  page. 

Practice Releasing Tension & Letting Go

Natural relaxation exercises can be used to reduce emotional reactivity. Look up "abdominal breathing" and "progressive muscle relaxation" on Youtube. Soothing imagery exercises are also available. Guided instruction in Progressive Muscle Relaxation is also available on my Resources page.


Consider a Brief Course of Medication

You may consider a temporary course of emotion-regulating medications. Medications commonly prescribed for tinnitus distress fall into two categories (used separately or in combination). These are prescription medications available through a primary care doctor or psychiatrist:

  • Benzodiazepines (e.g., Klonopin, Ativan, Valium, Xanax) provide immediate, temporary relief from stress and anxiety. They can provide a much needed break from tinnitus, space to redirect attention to other areas of life. Benzos are most often used at bedtime to help with sleep, but can be used at other high stress periods throughout the day. 
  • SSRIs (e.g., Prozac, Zoloft, Lexapro) and SNRIs (e.g., Cymbalta) are antidepressants that can be very effective in reducing both anxiety and depression. Unlike benzos, these must be taken daily, and can take up to several weeks to achieve full effect.

Use Background Sound

Most people with tinnitus respond favorably to background sound. Tinnitus sounds will often blend into a carefully selected background. While tinnitus itself does not change, subjective perception of tinnitus can soften considerably. This gives you a break from the noise and some space to shift your attention onto other things. So called "sound therapy" is not a permanent solution for tinnitus, but can be used to help you through tough periods, then phased out as recovery proceeds. 

Accept All Available Support

Some people in the throes of tinnitus distress dismiss medication and background sound as “crutches”, and their use as a sign of weakness. If this is you, please consider that something inside you has broken. Crutches are designed to hold us up and help  us function while our bodies heal. You can wean yourself off these crutches once the healing is complete. In this time of crisis, please allow yourself these helpful supports! 

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