CBT for tinnitus Skills 

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CBT is a program of exercises, ways of thinking, acting, and paying attention, that work together to promote habituation, by reducing distress, redirecting attention, and rejoining your life!

CBT skills can be learned, and will improve with practice. The ultimate goal is to apply CBT during key moments of the day when your new skills are needed most. With consistent practice and application, you can expect gradual improvement—reduced distress, reduced tinnitus awareness. 

cbt skills work together to help reduce emotional reactivity, redirect attention, and rejoin your life!

Careful Thinking: Take a Recovery Perspective on Tinnitus

The first step in reversing the cycle of tinnitus distress is to deliberately re-engage the organ so often neglected during times of strong emotion, your reasoning brain. Emotion-driven, negative thinking deepens distress and keeps you trapped. From a gloom and doom perspective, your future will always look grim. In careful thinking you'll take the pro-recovery perspective that people can and do adapt to tinnitus, and you'll get your thinking focused on doing just that. 


You’ll take careful inventory of what you can and can’t control—about tinnitus, your emotions, your recovery—to accept what you can’t change, and to redirect your effort toward changing what you can. And in place of a gloom and doom inner voice, you’ll cultivate a supportive, encouraging voice, to coach you in applying your new skills and guide your recovery.  

Careful thinking also means letting go of harmful thoughts, before they cause damage, and getting your attention on to the courageous work of rejoining your life. 

Mindfulness: Acknowledge, Let Go, Redirect

We humans excel at changing things we don’t like. When it comes to accepting things we can’t change, our abilities pale. Mindfulness provides a skill-set for acceptance, a practice ground for exploring a softer, more accepting relationship with tinnitus, with emotional reactions, with your entire life. 

Mindfulness works your letting go muscle. It’s an antidote to resistance. In place of a subjective, emotion-driven stance, you practice taking an objective, nonjudgmental stance toward tinnitus, acknowledging tinnitus as you would any other naturally occurring sound, as a set of sensory signals. Neutralizing tinnitus in this manner inserts space, a buffer, a little much-needed emotional distance between you and tinnitus sounds. And by taking a lighter grip, tinnitus becomes more tolerable, and attention can be freed up for rejoining your life.

reduce stress by attending to tinnitus in a neutral, objective manner. 

Letting go and allowing tinnitus to exist is a profound act of courage. Specific strategies are used to ease the way. You’ll combine mindfulness with relaxation exercises—abdominal breathing and progressive muscle release (PMR). You’ll practice hearing tinnitus without getting caught up in negative thinking. And you'll practice redirecting attention to other, soothing sounds and sensations, that can be used to anchor attention away from tinnitus.


Take Courageous Action to Rejoin Your Life

Behavioral avoidance is the most disruptive feature of tinnitus distress. If not checked, it can pave the way for more serious problems, like anxiety disorders and depression. By now, you’ve likely withdrawn from areas of life that, prior to tinnitus, had been important sources of enjoyment, meaning, and value. Cutting yourself off from life is a radical response to tinnitus. It sends your primitive brain the powerful message that tinnitus is a threat of the highest magnitude. CBT helps to get out of your ears and into your life! 


There are many causes of tinnitus related avoidance. Struggling with emotion and concentration makes it hard to remain at school and work. Preoccupation with tinnitus makes it difficult to socialize. Misconception about safe environmental noise levels trigger avoidance of restaurants, bars, gyms, movie theaters, sports events, concerts. Avoidance through overuse of earplugs and over-masking can compound the problem.  Many people with tinnitus disrupt their lifestyles further by eliminating salt, caffeine, and alcohol, when there is no scientific basis for doing so. 

CBT provides structure and guidance for reclaiming areas of life lost to tinnitus. Armed with careful thinking, mindfulness, strategies application of background sound, and the smart use of hearing protection, you enter a program of gradual desensitization through exposure to avoided areas. You choose where to start and you control the pace of change. Building confidence at lower levels prepares you for bigger challenges. Through courage, patience and commitment, you can resume a full life, even with tinnitus.  

Relaxation for Tinnitus Distress

Relaxation exercises provide another way to get control over your response to tinnitus and the emotions it triggers. Progressive muscle relaxation (PMR) and abdominal breathing (AB) are relaxation strategies widely used throughout healthcare to help lower emotional reactivity. Together these strategies provide a concentrated dose of the essential benefits available through more time-consuming practices.  Relaxation training takes about 20-30 minutes a day to learn. Once your skills have developed, they can be incorporated into your daily life. Through regular practice, they can become second nature.


 Therapeutic Sound 

You can’t change tinnitus, but you can alter the soundscape against which your tinnitus is heard. Objectively your tinnitus won’t change, but it may be less prominent, less intrusive, and more readily blend into the background. This can provide a much needed break, and make it easier to redirect attention to other areas of life.

Background sound is a common adjunct to CBT for tinnitus. Like a brace for an injured limb, it supports healing, and can be gradually phased as you recover. The ideal background sound is one that both soothes your emotional reaction and blends with your tinnitus (e.g., waves, rain, white noise). Interesting sound, intended to capture attention, like music with lyrics, audio books, podcasts, TV, etc., can also be helpful.  

In CBT, background sound is used strategically, at the times of day it’s needed most. For example, many people use background sound to help with sleep and concentration, but get along fine the rest of the day. You can guide yourself through the process of selecting and applying background sounds that help with your tinnitus. Apps and websites are available that offer an array of sounds to try, and include timers and other helpful features. Cognitive behavior therapists often work in conjunction with audiologists who specialize in sound therapy for tinnitus. Audiologists provide in-ear sound delivery devices which have some advantages over external speakers and earbuds.

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