In his seminal self-help book "Tinnitus: Living with the Ringing in Your Ears", CBT tinnitus researcher Richard Hallam describes four stages of habituation to tinnitus. These stages are not scientifically-derived. They are drawn Dr. Hallam’s decades of experience coaching hundreds of people through tinnitus distress. 

Stage One

  • Persistent awareness of noises except during sleep and masking by louder sounds. 
  • Frequent worrying and depressing thoughts about tinnitus.
  • Concentration on mental tasks difficult to sustain for more than a few minutes.
  • Absorbing activities provide only slight distraction. 
  • Insomnia severe (if present). Cumulative sleep loss in some cases necessitating medication. 

Stage Two

  • Intermittent awareness developing—especially during absorbing activities. There are moments when you are aware that you have not been aware of tinnitus. 
  • Improvement in concentration reflected in increasing engagement in usual activities
  • Beginnings of emotional acceptance (desensitization); the implications of the noises no longer seem catastrophic. 
  • Gradual return to normal sleep pattern (if disturbed).

Stage Three


  • Awareness mainly limited to periods of fatigue, stress or quiet.
  • Noises intrude mainly when listening and mental concentration are important (at social gatherings, the theater, lectures, etc.)
  • Noises annoying rather than emotionally distressing

Stage Four


  • Attention rarely given to the noises. Attention limited to periods when they are louder than normal or you are reminded of them.
  • Noises do not intrude into normal activities. 
  • Emotional acceptance (desensitization) achieved—the noises are neither pleasant nor unpleasant.