WHAT IS COGNITIVE BEHAVIORAL THERAPY (CBT)?
CBT is the most researched, clinically-proven program for tinnitus distress. It is the only approach to tinnitus recommended by the American Academy of Otolaryngology (Ear-Nose-Throat docs, or ENTs). First developed in the 1980’s, and guided by rigorous scientific research, CBT for tinnitus has undergone decades of improvement. The program described here combines behavioral (action) and cognitive (thinking) strategies with acceptance and mindfulness techniques.
HOW CBT WORKS
We don’t know what causes tinnitus, but we do know what causes tinnitus distress. Surprisingly, it’s not the tinnitus. Research shows that tinnitus characteristics, like volume, pattern and pitch, have no bearing on who does and does not adapt to tinnitus. What has been shown to cause the distress associated with tinnitus is how we respond to tinnitus—how we think, act and attend. These factors determine our emotional course with tinnitus. CBT is a program of skills and exercises to change your response to tinnitus. The goal is to reduce distress, redirect attention, and rejoin your life!
Careful Thinking: Take a Habituation Perspective
Thoughts have power, over how we feel and behave. The gloom and doom thinking, common to tinnitus, while understandable, only fuels distress and maintains negative focus on tinnitus. CBT takes the perspective that even if your tinnitus doesn’t go away, you can resume a full, healthy, productive life. Careful thinking is a set of skills to guide pro-recovery thoughts and actions. You'll learn to base your judgments and expectations about tinnitus on facts and evidence, rather than worse-case-scenarios and horror stories from the web. You'll make a careful review of what you can and can't control—about tinnitus, your response to tinnitus, the surrounding circumstances—to accept what you can't change, and redirect your effort to changing what you can. And you'll learn to coach yourself in a hopeful, effective manner.
Mindfulness: Take Charge by Letting Go
It’s not hearing tinnitus but how you hear tinnitus that matters. Tinnitus distress is characterized by hypervigilance—the self-protective impulse to closely monitor tinnitus: "What's my tinnitus doing? Is it getting better? is it getting worse?" Mindfulness can help you let go of tinnitus, let go of the gloom and doom thoughts, of impulses to escape and avoid.
With mindfulness you'll practice hearing tinnitus in a neutral, objective manner, like any other meaningless sound to be dismissed to the background. You'll also practice broadening attention away from tinnitus, to shift your focus to more important, sounds and sensations, the stuff of life. Mindfulness is practiced daily, then applied as a coping skill when you hear your tinnitus—during periods of concentration, when falling asleep, and when masking fails.
Background Sound: Craft Your New Soundscape
Carefully crafted background sound is the oldest, most intuitive form of tinnitus relief. Most tinnitus sounds will blend into the right background. This provides a much-needed break from the sounds, and makes it easier to redirect attention away from tinnitus and onto the important stuff of life. In CBT, background sound is used as needed, not 24/7 as in many tinnitus approaches.
Apply Your New Skills to:
Improve Sleep with Tinnitus
Impaired sleep is the number one complaint about tinnitus. Having to adapt to tinnitus is tough enough. Losing sleep and spending hours in bed, tossing and turning while obsessing about tinnitus, makes everything worse. Here's where you'll apply your new CBT skills—careful thinking, mindfulness, background sound—to let go of tinnitus, redirect attention to soothing sensations, and set the stage to drift off to sleep.
Take Courageous Action to Rejoin Your Life
The surest strategy to promote habituation is to get active again. Fight the urge to avoid, escape, and generally drop out, and instead, whenever possible, choose to re-engage in life. Careful thinking, mindfulness, and background sound are applied to ease the way. And these additional strategies can help:
Practice Hearing Conservation: Living fully with tinnitus means learning to use proper hearing protection. Knowing you've taken this precaution can reduce stress and increase confidence as you reenter loud settings. Over-the-counter earplugs, custom-molded "musicians" earplugs, noise-cancellation headphones, and (for musicians) in-ear stage monitors, are commonly employed.
Practice Graded Desensitization: People who are distressed by tinnitus often develop an exaggerated fear of sound called phonophobia. This can reinforce avoidance and slow recovery. Armed with with CBT skills, and appropriate hearing protection, you'll reenter avoided settings a little at a time, building confidence at one level before moving on to the next. In this way, you can gradually overcome your fear and regain comfort in the full range of settings.