Connection Between OCD and Tinnitus — Can ERP Help with Habituation?

For context, a brief summary of my tinnitus experience: I believe it started after an infection (viral labyrinthitis is what my ENT thinks?), in late July. This led to ETD which is my main issue now. The tinnitus started mild and got worse over the course of about two and a half weeks, cumulating in mid-August as a debilitating ear-piercing high-pitched tone. After staying at the maximum intensity for about a week, it has been in a long and slow decline, for a bit over a month and a half at this point. I've been through a lot of strange sounds but at present it is a mild "soft ring" or hiss and I am able to ignore it most of the time. It's always been just in my right ear (though sometimes it is hard to tell as it seems to be coming from inside of my head). Because it seems to be improving still, I'm hopeful that it will eventually go away completely, but it's too soon to say... I could end up with a mild form long-term, but regardless, I feel lucky compared to some of the other people here.


Now, for the point of this post... It's a little long, just bear with me.

I've come down with a form of obsessive compulsive disorder (OCD). I believe it is a follow-up of sorts to my tinnitus — As my tinnitus has become more and more mild, my mind has found something else to latch onto. It's been really bugging me for a few weeks now. I don't want to describe my OCD much because I'm wary of giving it to anyone else, but I will say that it is all mental, it is a recognized form of OCD, and I didn't even realize that it is OCD until I started reading up on it earlier this week. (Unlike tinnitus, this OCD I purposefully avoided reading up on for a while, because I didn't want to read something that I could not un-read that would make it worse... This is also why I am being light on details regarding my specific OCD in this post.)

As I was reading I came to understand that the desired goal of someone with OCD should be to habituate to it. (There's a word that tinnitus people also know!) This is the only way to reduce the symptoms long-term. There is a cognitive behavioral therapy technique called ERP (exposure and response prevention) which aids with habituation. I've been practicing ERP against my OCD for a few days and I've noticed a significant reduction in the anxiety level associated with my OCD. I think that it really works, if you can get yourself in the right mindset and set expectations appropriately.

OCD comes with of course an "obsession" and a "compulsion". The "obsession" is generally rooted in some sort of anxiety or fear, and the "compulsion" is an attempt to deal with that fear. There may be triggers that set it off. Take a hypothetical example...

Trigger: touching a doorknob
Fear: germs
Obsession: gotta keep those hands clean
Compulsion: wash hands ASAP!

Indulging the compulsion may lead to a short-term drop in the anxiety level, but long-term it will not solve the problem. Here's how ERP works. You set aside some time to willfully expose yourself to the trigger, but refuse to follow through with the compulsion. This will lead to a short-term increase in your anxiety level. However, by practicing this for an extended period of time and repeatedly, the anxiety level during the exercise should begin to decrease. This is "within-trial habituation". Over time this should lead to "between-trial habituation" as well, which would be a decrease in the anxiety level when you are not actively seeking to expose yourself to the trigger, but when it happens upon you during the course of the day.

In terms of the example above, an ERP session may be holding onto a doorknob for a few minutes and then refusing to wash your hands afterwards. People may have multiple triggers, in which case you start with the "easiest" one for purposes of ERP and work yourself up to the more intense ones.

While practicing ERP, it is important that your goal is not to eliminate the symptom (the obsession)... Just the anxiety level associated with it. Complete resolution of the symptom may not be possible, but if the anxiety level is zero or near zero, then who really cares?

Now, in my case, I mentioned that my OCD is mental, something that I find myself thinking about regularly. My fear was that I would not be able to stop thinking about it, and this was the root of my anxiety. My compulsion was to try to distract myself away from it, and to avoid triggers. I have a few different triggers, one of which was the tinnitus sound or strange feelings coming from my ear as a result of ETD which are unavoidable at this point, but others I would try to actively avoid. As I mentioned, what I have is a recognized form of OCD and ERP is the suggested treatment. In my case, this involves exposing myself to a trigger on purpose (not hard) and accepting the thoughts that follow, not trying to distract myself away. I have been successful in reducing my anxiety level significantly over the course of a few days, mostly by accepting this as a persistent issue and avoiding my compulsion to try to distract myself away. It's still there, but it doesn't bother me so much anymore.


All of this to say... I'm now pretty sure that I developed OCD shortly after I developed tinnitus. I never had a problem with OCD before, but I believe that I had OCD with the tinnitus itself as the obsession. As the tinnitus began to fade, my mind found a new obsession, though the compulsion and fears are similar. I didn't recognize it as OCD until today.

I wonder how many people have OCD as an add-on to tinnitus, but don't realize it. I've seen posts from some people on this board who are having a hard time dealing with the tinnitus who I feel may also fall into this bucket. It would be something like this...

Trigger: the tinnitus sound itself (impossible to escape)
Fear: omg, this is a terrible sound, I'm going to be listening to this forever, I'll never hear silence again, my life is over, etc.
Obsession: figuring out a way to escape from tinnitus
Compulsion: over-analyze the sound (trying to decide it is getting better or worse), try to distract away from it, spend hours Googling for any hope of total relief, etc.


The compulsions that I listed I believe are healthy early on, to some degree — of course you need to seek out information, figure out what you're dealing with, and I believe that masking can be very useful for "newcomers" to get a break from the sound while they come to terms with it and the psychological whirlwind that comes with tinnitus onset. But, after some weeks, I believe that they can become unhealthy (especially if the tinnitus is going to be long-term).

I looked and I didn't find much material (on this board or elsewhere) linking OCD and tinnitus. Since ERP helps with most forms of OCD, I started wondering if ERP would help with tinnitus for people who are fixated on it and having trouble habituating, as this may be because of OCD. Again, the goal of ERP would not be to reduce the sound of the tinnitus, just the anxiety level associated with it (in other words, habituation — yeah, it would be nice to get rid of the sound completely, but if that's not possible, getting rid of your negative reaction to it is the next best thing). Part of the result would also be to learn to stop reacting so strongly to the tinnitus and focusing on ways to avoid it, and learning to just "roll with it" — this is what I have been able to achieve with my current OCD. Unfortunately, I cannot try this myself with tinnitus as my tinnitus has already dropped to an easily manageable level, so I'm not sure if it would actually work... But, it would have been interesting to try two months ago.

I think that it would involve just setting aside time to sit and listen to your tinnitus, without analyzing it, and observing to see if your anxiety level drops during this period. (If you get bored or your mind starts to wander elsewhere, it's probably worked somewhat.) It isn't reasonable to expect the anxiety to completely go away... just a reduction is success. With repeated sessions, it may be possible to achieve some degree of "between-trial habituation".

If after reading this you think you may have OCD on top of tinnitus, maybe think about reading up on ERP and giving it a go for a few days. It may also be worth seeing a psychiatrist who deals with OCD.

 

I feel your analysis is spot on.
I even starting laughing reading parts of it because I felt very identified with what you said.
What I used in the beginning to stop the vicious cycle of worrying was recording myself after the bad T days were gone, and telling myself that it all gets better after the spikes doesn't matter how bad they are or take.
Somwhen I had the spikes again I listened to myself giving me hope and it worked big time like a charm.