CBT for Tinnitus & Hyperacusis



What is Tinnitus?

Tinnitus is the name used to describe a wide range of sounds heard in the absence of any external signal. Also called “ringing in the ears” and “head noise”, tinnitus sounds consist, for example, of tones, whistles, hisses, static and pops, which can occur alone or in combination, with volume and patterning unique to each person.

What is Hyperacusis?

 Hyperacusis, a condition commonly associated with tinnitus, is experienced as uncomfortable sensations triggered by certain sounds. These sensations, often described as “nails on a chalkboard”, can result in even greater distress than that caused by tinnitus.

Tinnitus & Hyperacusis on the Rise

Tinnitus is a common condition, occurring in about 10 to 17% of the general population. Because of its association to acoustic trauma (prolonged exposure to loud noise), tinnitus is the number one cause of disability among returning war veterans. And due to the proliferation of personal listening devices, such as iPods, there is good reason to believe tinnitus is on the rise. About half of all people with tinnitus also experience “hyperacusis”, an over-sensitivity to loud sounds. To learn more about tinnitus and its effects, visit the American Tinnitus Association web site, at www.ATA.org.

Tinnitus, Hyperacusis and Emotional Health

Studies show that about 50% of tinnitus sufferers are psychologically affected by their condition. The emotional impact of tinnitus can range from simple annoyance and frustration, to anger, anxiety, sleep disturbance and impaired concentration, to more severe conditions like generalized anxietypanic and depression. It may also be associated with specific phobic conditions around sounds. For over 20 years cognitive behavior therapy (CBT) has been used to effectively treat the emotional consequences of tinnitus and hyperacusis. CBT may be used in conjunction with other treatment approaches such as tinnitus retraining therapy (TRT).

Cognitive-Behavior Therapy for Tinnitus and Hyperacusis

Cognitive behavior therapy plays an important role in the overall assessment and management of tinnitus. The first step is to see a medical specialist called an otolaryngologist for evaluation. This assessment will include a hearing test provided by an audiologist to measure the presence of any hearing loss associated with the tinnitus.

Cognitive behavior therapy may then be introduced to reverse the negative impact of tinnitus on your psychological health and quality of life. CBT is often used in combination with sound stimulation therapies, such as TRT or Neuromonics. Primary to all treatments for tinnitus is the promotion of a neurological process called “habituation,” that is, the gradual reduction in perception of tinnitus sounds over time. Through habituation you will come to “ignore” the tinnitus sounds and resume life as usual.

While both sound stimulation therapies and CBT promote habituation, cognitive-behavior therapy also helps by addressing anxiety, anger and depression which often result from tinnitus. While debilitating in their own right, these negative emotional states also serve to block habituation, thus prolonging tinnitus-related suffering. CBT works to break this destructive cycle.

Steps for Treating Tinnitus and Hyperacusis with CBT:

1. Health Education: In your search to understand your condition, it is likely that you have fallen victim to some of the many common misconceptions about tinnitus. Unfortunately, these are all too often conveyed by insensitive, poorly informed medical professionals and unscrupulous marketers. In order to correct these misconceptions and to empower you to take an active role in your treatment, Cognitive Behavior Therapy begins by educating you about tinnitus. The prevailing scientific model of tinnitus and its effects on emotional wellbeing, along with the range of options for optimal management of tinnitus are discussed.

2. Relaxation Training: As described above, stress, anxiety and anger are common emotional consequences of tinnitus. Evidence suggests that these negative emotions may activate a cyclical process which can further intensify the negative effects of tinnitus. Relaxation techniques help break this cycle, reversing its ill effects. In cognitive behavior therapy, Progressive Muscle Relaxation (PMR) and abdominal (diaphragmatic) breathing are used to promote a relaxed state that can then be attained during stressful situations throughout the day.

3. Cognitive Therapy: Cognitive therapy is the process of “separating fact from fiction” regarding the cause, persistence, and long term consequences of tinnitus. Misunderstandings about tinnitus can lead to “catastrophizing”, a dysfunctional cognitive pattern in which the sufferer obsesses about “the worst case scenario”, almost as if it has already occurred. Catastrophizing and other dysfunctional cognitive patterns intensify the negative emotions associated with tinnitus, further preventing acceptance, coping and habituation to tinnitus sounds. The goal of cognitive therapy is to adopt a realistic, effective attitude in dealing with tinnitus.

4. Exposure/Mindfulness: Exposure, the single most reliable mental health treatment on record, is a cognitive-behavioral technique used with a wide range of negative emotional states. Pioneered for tinnitus in the 1980s, exposure was perhaps the first psychological treatment for this disorder. During exposure, the person uses relaxation and cognitive therapy to assume a relaxed body and clear, accepting mind, in order to intentionally “listen to” tinnitus sounds for a few minutes at a time. This process, while challenging at first, promotes acceptance and habituation. Exposure helps you detach from tinnitus sounds and reengage in life. In the form of “mindfulness” exposure may be used throughout the day, by assuming a relaxed, accepting response whenever you become aware of your tinnitus.