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Five reasons why psychology can make a difference for patients with tinnitus

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I have been suffering with tinnitus since childhood and I found it very difficult to come to terms with the condition at first. A significant part of my research into tinnitus aims to raise awareness, improve treatment pathways and, notably, demonstrate why psychological solutions can be life-changing for tinnitus patients if applied correctly.

There are many reasons why turning to psychological solutions, such as mindfulness, meditation, or Cognitive Behavioural Therapy can be instrumental in allowing patients to lead a better life.

Tinnitus sufferers are three times more likely to suffer with clinical depression.

Chronic Tinnitus is present 24/7. It represents a continuous noise (usually produced by a damaged ear signalling the brain in the absence of corresponding external stimulus) without respite. The patient has no control over the condition, with the tinnitus sensation most prominent in times of stress and when quiet.

Those with tinnitus report emotional fatigue and exhaustion, and this sets the scene for clinical depression and a sense of helplessness. There are also theories that depression and anxiety may predispose for tinnitus. This is a key reason why, in addition to clinical treatment, psychological solutions are essential in helping tinnitus sufferers to live a better life. Turning to mindfulness, Cognitive Behavioural Therapy and counselling have proven significant in improving the quality of life for tinnitus patients.

Research has likened tinnitus to bereavement: saying goodbye to life before tinnitus.

Tinnitus can be extremely distressing, and there is no cure. Some interventions exist, but for specific populations; and there is nothing which is independently evidenced, safe, and which works well. Currently, the individual needs to accept that their tinnitus is permanent and must be adapted to. That their life before tinnitus has ended, and efforts must be made to live with and in habituation to tinnitus, rather than seek cures which do not exist.

Tinnitus can cause significant comorbidities with clinical anxiety, depression and insomnia.

Currently, the most effective interventions for tinnitus distress are psychological ones. This does not suggest that tinnitus is psychological – but that efforts can be made to reduce the conscious desire to listen and attend to the unpleasant tinnitus sensation. Key to this is reduction in anxiety, so that tinnitus is not seen as a threat, as the brain will always orient towards threat.

For my upcoming paper, 105 patients with chronic tinnitus took part in a study assessing how mindfulness can help reduce the impact of tinnitus on the patients’ quality of life. An intervention group consisting of 54 participants were given a variety of online mindful body scans, one per week for eight weeks. 30% of this sample self-reported a clinically meaningful reduction in their tinnitus distress after two months. In addition, they reported a significant reduction in negative thoughts about tinnitus as well as a significant improvement in mindful thought – which is associated with reduced risk of depression and more effective coping strategies.

Tinnitus sufferers can feel alienated from their loved ones, as non-sufferers don’t understand what it’s like to live with the condition.

For now, there is no recognised objective measure of tinnitus distress – which is problematical. It’s currently impossible for someone on the outside to tell if an individual has tinnitus. Therefore, it’s not possible to appreciate what the condition is like, or the upset it causes. Playing external noises all day and following people around is just not the same.

The tinnitus patient is often anxious, depressed, exhausted and unable to sleep effectively. There is value in speaking to others who have the condition, to empathise, to be understood, and to share tips on coping. Tinnitus UK runs more than 100 self-help groups in the UK, some online and some specialised (e.g. for musicians).

It can be very distressing on a daily basis.

Research has found that 87% of tinnitus patients think about it every day and 35% every hour. There is no escape from the tinnitus sensation. It is there all of the time – as it is generated by the ear. An external noise will give you something else to listen to, but it is not going to stop the tinnitus sensation. Many people worry as to what tinnitus signifies. For example, will it get worse? Does it mean that your hearing is damaged? Something more serious?

As such, people focus on their tinnitus, so it seems to get louder, which increases worry, making it more likely to that you concentrate on it further, so it gets even louder. This is what we call a positive feedback loop, and while this makes grim reading, it is also the reason why psychological interventions are effective. If you are paying more attention to your tinnitus when you are under pressure, it is also possible to pay less attention to your tinnitus when relaxed. However, if there is a sudden and significant surge in tinnitus loudness, you should see you GP.

Dr James Jackson is a Reader in Psychology at Leeds Trinity University, Chartered Psychologist and Associate Fellow of the British Psychological Society. James has an international reputation in the field of tinnitus research and is currently serving on the Professional Advisory Committee of Tinnitus UK. James has tinnitus and severe hearing loss – his doctorate considered the effects of tinnitus on concentration and task performance.

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