How CBT Helped Me Live Again — Dr. Hubbard's Story

It's tough to revisit the time in my life when I first encountered tinnitus. But it's been useful, as I can see how far I've come from those early, tortured months. I wish for others to find hope and inspiration in my story:

My Condition

As for my condition, I hear two constant, high-frequency tones and a pulsing hiss. The sounds are sufficiently loud that I can detect them against most levels of background noise. In response to certain external sounds—sharp, high frequencies, any loud noise, booming bass—my hearing distorts, and i feel a nails-on-a-chalkboard-like sensation in my inner ears. Everything is worse on the right side, where i have high-frequency hearing loss.

Hijacked

When the condition came on suddenly in 2005, it hijacked my life. Like most of us, I found it difficult to fall sleep, and once asleep, the tones would wake me up. I took to wearing earplugs around my young children, whose high, loud voices triggered distortions and swiped the chalk board in my inner ear. At work, in the quiet of my office, the tones were blaring, and even slightly raised voices triggered the sensations. And I was haunted bycatastrophic thoughts about where it would all end.

As an avid rock musician, I tortured myself with the belief that my prolonged indulgence in loud music had caused the condition. I faced the imposed reality of a radical new soundscape: one that was muffled, infected with alien tones, and distorted in response to my own singing voice.

I was panicked, desperate to escape the sounds and sensations that inhabited my head, that were destroying my life. Once I began to truly believe there was no cure, I became depressed, withdrew from friends and family, and abandoned my musical activities. I came to avoid settings that I irrationally believed would result in further damage to my hearing, like parties, movies, and restaurants. Obsessed with the unwavering belief that my hearing and my life could only get worse, I considered a foreshortened future.

Cognitive Behavior Therapy (CBT)

For help, I turned to Cognitive Behavior Therapy (CBT), an approach I understood intimately through my work as a psychologist, and one that also happens to be an evidence-based treatment for intrusive tinnitus. I used CBT to help manage the fear, anger and despair brought on by my condition, to grieve the loss of crisp, clean hearing, and to hasten habituation and adjustment.

Cognitive Skills

First and foremost I had to deal with my negative thinking. It’s so easy to become obsessed with horror stories about tinnitus. I recalled my meeting years earlier with a former patient, whose hearing condition affected him so severely that he could barely tolerate sitting in my office. At the time I didn't understand what he was going through. But once I had caught a taste for myself, I could not get this man’s story out of my mind. I felt certain that my condition would worsen, that I would not be able to live with it, that his horror would become my future.

Worst-case-scenario thoughts like this, so common for tinnitus sufferers during the early months, greatly fueled my fear and despair. I turned to CBT's cognitive skills to help keep my thinking grounded in a more reasonable reality. I learned the facts about tinnitus: that the condition is rarely as disabling as it had been for my patient. That it's not a death sentence, because even if the sounds and sensations don't go away, there's a natural process called habituation, through which the brain can learn to"tune them out." To remind myself of these facts, and to encourage a positive attitude, I wrote out some grounded, reasonable thoughts to review throughout the day, something like:

"OK, maybe my condition won't go away, but over time, I will learn to live with it, adjust to it, tune it out. And I certainly hope it doesn't get any worse, but I refuse to let my brain 'what if' me to death. I choose to live! And in the event that my condition does get worse, then I will be just as determined as I am now to accept, adjust and habituate."

Thinking this way calmed me down, and it helped redirect my energy to what I needed to do to get better.

Acceptance & Mindfulness

And that meant accepting into my moment-to-moment reality the overwhelming truth that I had no direct control over the sounds and sensations of tinnitus. I could not turn them off even for a minute, to catch my breath, to brace for the next assault. For me it was 24/7. The sweet relief of silence was gone forever. It was one thing to understand this intellectually, and quite another to accept it at the core of my experience, in my heart-of-hearts. How could I live in harmony with a condition that I experienced as a monster, that every fiber of my being hated and resisted? To nurture this deep acceptance, I used a meditative technique called "mindfulness."

Mindfulness is the primary acceptance strategy used in CBT. It strengthens your ability to create mental "space" between an unwanted, distressing stimulus and your response to it. If you can't directly control a stimulus, then having a little space tostep backfrom it provides relief. Itsoftensyour experience of the stimulus, making it easier to tolerate and to try out more effective ways of responding. I think of mindfulness as stepping out of a fire: youstill feel the heat, but are no longer consumed by the flames.In CBT, mindfulness is used to help with difficult, unwanted experiences, like recurrent depression, generalized anxiety, and compulsive urges. Mindfulness-based programs for tinnitus, based on the work of Jon Kabat-Zinn, are currently under development. But in 2005, in the throes of my distress, I stumbled on the approach quite by accident.

My practice of mindfulness predated my tinnitus. I would regularly set a timer, sit still, and calmly observe my breath. When my attention wandered, I would simply notice where it had gone and gently escort it back. Once my hearing condition set in, practicing mindfulness was excruciating, as all I could think about was the screeching in my ears! The sounds were so loud, so upsetting, so distracting, that there was no way I could calmly focus on my breath.

Rather than give up, I decided to make tinnitus sounds themselves my object of mindfulness. I used the same approach I'd learned to help my patients soften their experience of depression, anxiety, and OCD, to soften my experience of tinnitus. I practiced listening to tinnitus sounds,and feeling tinnitus sensations with an open, accepting attitude, allowing them to exist as part of my new experience of sound. As you can imagine, the first weeks of mindfully listeningto tinnitus were extremely challenging. But through patient, persistent effort, it got easier, and I believe, greatly accelerated my adjustment and habituation.

Exposure

With the help of cognitive skills and mindfulness, I was ready to take on an area of CBT called “exposure.” Exposure has been used effectively in CBT for decades to promote habituation and adjustment in phobias and panic disorder. So I considered it a perfect tool to help me habituate and adjust to tinnitus.

Exposure provides opportunities for your brain to learn that the sounds and sensations of tinnitus are not dangerous, just meaningless stimulation that can be tuned out. The brain has a natural tendency to tune out, ignore,habituate to, meaningless sound. Just as it can learn to tune out the ticking of a new clock, the din of a dining hall, the whistle of a passing freight train for those living near the track, your brain can learn to tune out the sounds and sensations of tinnitus. Once this occurs, your distress goes down, you are no longer preoccupied with tinnitus. Through exposure, you learn that, even when you are distressed, you can handle the challenge and remain in the situation by using cognitive skills and mindfulness. Over time, your experience becomes easier, your confidence and distress tolerance increase. You can resume avoided activities and rejoin your life.

By slowly and gently reversing my avoidance and reintroducing myself to sound, I created opportunities for my brain to learn that my tinnitus was not important and tune it out. I gradually reduced my use of external masking, when working alone at my desk and when falling sleep at night. I challenged myself to participate in parties, attend movies, eat in crowded restaurants. I gradually reduced the density of the earplugs I used to avoid inner ear sensations, for example, when playing with my children or putting away dishes.

At first, these experiences were upsetting, and triggered my negative thinking, which threatened to make everything worse. But exposure is an opportunity to work through these difficult emotions and counter emotional thinking with grounded, reality-based thinking. And every few minutes, I would stop what I was doing, close my eyes, and practice resuming a mindful, accepting stance toward the sounds and sensations that had begun fading into the backdrop of my new life. Eventually, I noticed that I had stopped thinking about tinnitus and was instead absorbed in what I was doing. Sweet habituation!

Living Again!

Armed with the tools of CBT—cognitive skills, mindfulness and exposure—I gradually resumed all of the activities I had abandoned. I'm engaged at work, at home, fall asleep without masking, and perform with a new musical ensemble– this time, no amplifiers! It took time, patience and a healthy dose of courage, but I've made a full adjustment to life with tinnitus. I rarely notice the sounds and sensations, and when I do, it is without the debilitating emotional weight they once carried. If I don't notice my tinnitus, is it still there? When I don't notice my tinnitus, I have my silence back!

 

Thank you for this Dr. Hubbard. This is a very inspiring story. I hope it encourages those who are still struggling and in that dark place.

 

Hi Dr. Hubbard,

One question I had was regarding your tinnitus prior to 2005. How bad was it, how often would you notice t, etc. Also, was there one incident that you think led to the 2005 increase.

Thanks,
Matt

 

Thank you for sharing your story. It is quite inspiring. I am currently in CBT and --don't laugh--I carry around two index cards--one with positive self talk and another with all the things to watch out for, i.e., catastrophic thinking, filtering, all or nothing thinking, etc. The cards are well worn and do help me. I tell myself when I'm not being helpful to myself in my thoughts and do mindfulness of breath as well as imagery and relaxation room techniques as well as other meditations and relaxation exercises. I've been doing them for months and am so much better. I am now seeing my CBT therapist every other week. On Thursday he said that I didn't need to come anymore--that he feels I'm on the road to healing myself but we both decided to explore some other life events that may help me.

 

@Dr. Hubbard
I'm really liking this;
"Rather than give up, I decided to make tinnitus sounds themselves my object of mindfulness. I used the same approach I'd learned to help my patients soften their experience of depression, anxiety, and OCD, to soften my experience of tinnitus. I practiced listening to tinnitus sounds,and feeling tinnitus sensations with an open, accepting attitude, allowing them to exist as part of my new experience of sound. As you can imagine, the first weeks of mindfully listening to tinnitus were extremely challenging. But through patient, persistent effort, it got easier, and I believe, greatly accelerated my adjustment and habituation."

That's meeting/beating T head-on! LIKE!

Rock-on Doc and thanx for sharing (very inspiring)j; in fact, I'm going to copy/paste your story and save it for later.

Mark

 

@Dr. Hubbard Thank you for sharing your heartfelt story with us. It is inspiring! Tell us, how long did it take until you no longer noticed your noise? Time is a major issue for most people. For many, tinnitus is a 24/7 distraction and annoyance. In general, people will start a therapy--whether it be psychological, TRT, or sound based--but will become quickly discouraged when they don't get results within a few weeks.

While everyone's journey is different, do general time guidelines exist for habituation? And how would you define habituation? Would you define it as not hearing your noise unless you seek it, or would you define it as not caring about your noise anymore? Or perhaps something else? I know the bottom line is your reaction to your noise. But I also wonder if most people achieve silence--or near silence--after they've stopped reacting to their noise for several years? I know five people with tinnitus--all of whom no longer hear their noise unless they seek it. But they've also had tinnitus for many years--at least five and as long as twenty.

 

I am a medical specialist who woke up one day in September of last year with bilateral tinnitus. It has been my constant companion since then. I guess I have used some of the techniques you described without realizing what they were. I use sound masking through hearing aids that I only use for that purpose and for me, nature sounds work the best. I also make sure I get to sleep by using melatonin + Benadryl to ensure 7-8 hours of uninterrupted sleep. Having tinnitus myself has enabled me to treat my patients with tinnitus with more understanding, compassion and success. It is all about feeling loss of control and regaining that control. Now when my tinnitus bothers me, I quickly retake control and move on. Beyond sleep medications, I rarely prescribe other drugs for tinnitus but I do strongly advise CBT and sound-retraining.

 

I like Dr. Hubbard's story and have come across it a few times.

With no cure and no effective treatment other than a psychological adjustment, we have to go with developing coping techniques, habituation, or acclimatisation, which is what I prefer to call it.

The very word ‘habituation’ has been defined too many different ways to mean anything specific any more.

When people state that they have habituated to the point where they hardly ever notice it, then I am sceptical on several fronts.

With no objective measure of tinnitus volume we have to wonder how loud their ‘loud’ actually was?
We can never know the volume of another’s tinnitus.

We obviously know that a much milder form is far easier to cope with - hence ‘their’ possible success.

However, Dr. Hubbard’s methods are similar to what I use in my admittedly ‘homespun’ meditation.
Having made myself physically comfortable, I am fully aware of my tinnitus noise.

However - I do not concentrate on it.

I clearly hear it, and then utilise a shallow diaphragmatic breathing practice to ‘take me away from the experience of noise’ into a much more peaceful setting, a meditational state, or a doze.

Having come round again I do feel less bothered by it, and much more relaxed, even though the sound hasn’t gone away.

Just thought I’d give my own two penneth.

 

I think you’re underestimating Dr. Hubbard’s lack of understanding for severe sufferers. At least from what I’ve read by him he seems to believe the vast majority can live a completely normal, totally unbothered life with tinnitus. Just react neutrally to the tinnitus and your brain will scan it out. The only people that struggle react negatively to their tinnitus.

This is from a recent ATA Podcast episode:

JC: I know Dean and I agree, as well as many other professionals with whom we've spoken, that people who have troublesome tinnitus have a significantly larger incidence‐‐ possibly most of them have some kind of a psychological basis for that problem. I believe that people with bothersome versus non‐bothersome tinnitus have a psychological basis for the difference in the tinnitus effects between them. Do you agree with that?

Hubbard: Yeah, that's true, and that's been demonstrated in numerous research projects. There are differences in how they think about tinnitus, how they pay attention to tinnitus, and how they behave around their tinnitus. So, their thought process becomes very negative. We call it catastrophic thinking, really jumping to the worst‐case scenario.

 

I have to thank @Autumnly for bringing my attention to this.

This conversation actually disgusts me.

It is a flat out denial of the differences in severity. I am an expert on mild tinnitus - I had it for 22 years. It didn’t bother me - a veritable stroll in the park. I used to joke about it.

“There’s a bloke whistling in my ear, and I wouldn’t mind but I don’t like the tune - it’s the one note samba.”

I had this level from 1992 until 2014 - then in the summer of 2014 I woke one morning with loud severe tinnitus.

The difference - pure and simple - was “VOLUME!!!” - not some ridiculously suggested psychological basis.

The physical destruction of cochlea nerve fibres due to acoustic trauma had led to severe tinnitus.

And those people above, discussing our condition, are supposed to be experts in tinnitus.

Excuse my French:

“They Don’t Know Jack Shit !!!!!”

 

Do you still find this helpful?

I'm looking for some positives.

 

Yes.

The very best way to get beyond the noise is to realise that you can still experience ‘Stillness.’

Stillness is there for every one of us.

‘Stillness’ of mind underlies everything.

Relax in the stillness beneath the mental noise.

Assume your most comfortable position for quiet meditation.
(For me - laying in a warm bath.)

Ask your tummy to take over your breathing for you, and cease all ‘conscious’ breathing.

Just observe your breathing without any degree of control.

Your breathing will continue automatically, just as in sleep.

You can leave your noise way behind.

Love,
Dave xx
Jazzer