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

 

Yes, great article!!! Thank you for this!!!

Greets Tom

 

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

 

If some tinnitus sufferers find that CBT or Mindfulness works for them then that's fine. What I find frankly a bit disturbing is the way that the CBT/Mindfulness industry is now setting itself up as the only realistic therapy for tinnitus. Others may have a different take on it, but in the UK CBT/Mindfulness is starting to monopolise the limited research funds for tinnitus (BTA are currently refusing to sponsor any therapies other than these two.)

My own experience of CBT/Mindfulness is of not finding it helpful for tinnitus and being told that was in some way my fault. Others I have spoken to also have had this experience. And call me cynical but one can't help notice that Mindfulness is now a lucrative industry which is extremely keen to promote its therapy and to try and discredit those who might dare to challenge its dominance. As I say, for those who find CBT/Mindfulness helpful good for them, but I don't think it should have the position of being the only option promoted for those suffering from tinnitus (check out the tinnitus wiki if you doubt this) or have the influence on the allocation of tinnitus research funds that it does have

 

Hey David I respect your opinion and I have not used any of these therapies. But if I may ask maybe this comment can be made as another thread entirely. I think it's topic that can draw a lot of attention and lots of different opinions. I just don't want this thread to go in the wrong direction and become a debate about cbt but again I do think it would make for an interesting thread where people can express opinions and discuss without taking away from the point of this thread.

 

@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.

 

David
I see your point (detracting from real T research) and would agree there are those out there that would take advantage; however I think it is the best we have right now and is not only a perspective look into the workings of T but also a stepping stone on the journey to 'T be Gone!' days. And, as a true capitalist -- if it doesn't work it (CBT) will die.

Mark

 

A reply to some of the polite criticisms made about my post on this thread. This was a thread started on CBT/Mindfulness as a potential "solution" (not cure) to tinnitus and having tried both these therapies I think I have a right to give my own personal perspective on them.

I do think that a debate about CBT/Mindfulness in tinnitus is important as in many countries these are the only therapies being proposed for tinnitus and in the UK at least (I can't speak about the USA etc) research money being spent on them is preventing money being spent on drug therapy, neuroscience.

I only wish the comment that "if CBT doesn't work it will die" were true. The continuation of numerous quack therapies for tinnitus (and I'm not saying that CBT is a quack therapy) just shows that this simply isn't true. For a condition with no current cure the desperate will continue to try anything.

While I'm not against anyone trying CBT/Mindfulness, I think that there are very many for whom these therapies simply don't work - and for these people I don't think they should be made to feel bad and told that it's somehow their fault that the therapies didn't work (my experience and the experience of others I know). None of us can really know what another person's tinnitus is like.

 

Bravo @Dr. Hubbard! Thanks so much for sharing. This should be made sticky, pinging our mods @Markku, @Steve & co

 

Loved your post! It is true though that when you dont notice your T, it is the closest thing to silence. When i lay in bed at night i focus off the T even though its ringing, i think of it as a computer noise in the backround and then it kind of feels like silence within when you take your mind off of it.

 

Completely agree. Money and resources need to be poured into finding a cure, as we can see with AM 101 and Autifony, which both seem like potentially ground-breaking drugs/cures. Without being cynical myself, it would be a tragedy if too much money was funneled into Tinnitus coping, and not T curing. And if I may so, almost immoral.

 

Fantastic post Dr. Hubbard. Thank you so much for sharing. That is a truly inspiring story.

 

@david c I don't think anyone is questioning your right to express your own opinion at all, those are what make this place so special. I think the feeling that it might be better placed in another thread was only because yours really is a topic worth talking about and this post was created in the "success story" section. To me that means it's more a place for celebration for the individual than commenting on the validity of their self-proclaimed means of success. Other than that, I'm sure everyone agrees with you that a cure cure would be the best!

Three cheers to however we all find our habituation/cure etc. and thank you Dr. Hubbard for giving your time to all of us here and for your inspiring story!

 

feeling quite close to death, one can only be grateful for the possibility of life.
life must and will find a way. god bless anyone who can shine a light for others
to follow. Knowing something is possible, which it is, is not enough. We need
the spirit of hope as provided here and by our loved ones.

 

Thank you ! well done, I am

 

Hello DR Hubbard, can I also ask like Jazz did above what you define as habituation and how long it took you to eventually get to that place, I think we would all like to be there one day. I have only just started with the advice from my audiologist to look into the mindfulness route and I am finding it a bit of a struggle at the moment to get my head in the right place as I do find it all a little abstract but will give it ago but can I ask that in your opinion even if not going that way and by just being positive and trying live as normal as possible etc I assume that eventually habituation will happen over a period of time ?

 

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.

 

All sounds so easy but in reality it is not.

 

Dr. Hubbard, Thank you for your words of encouragement to those of us who are experiencing T for the first time. It has been approximately 5 months since my onset of T. It all started for me shortly after a severe cold and bronchitis this past March. I do have a few questions for you and hope that you can help me to move towards the habituation phase of T. My question is about the breathing you are talking about, do you take deep breaths in and out of your nose? I need to understand what you are talking about when you talk about breathing? I would appreciate if you could explain what time breathing exercises you use. Also I am just curious if you have noticed any particular foods or drinks such as spicy foods or alcohol that increase your T? Also, did your T onset come and stay or did it come and go? Mine has been non stop since mid March. I am just looking for ways to cope with this condition that I am plagued with now. Thanks for all your encouragement.

 

Hello Doctor,

I have a query about Tinnitus. The day I have come to know that sounds coming into my ears, I had used Bleach and Harpic together that had generated a kind of gas and that gas was inhaled, after that I had a lot of problem in breathing and throat was also like chocked. This breathing and throat chocking was ok by following day but my ears were starting ringing.

My question is related with the incident happened above. Is Tinnitus started because of the above?

 

Im not anyway medical,but I don't think that would make or cause anything to do with T,breathing problems definate yes the bleach alone is caustic,harpic is caustic but with a scent if you like added to it,I'd be interested to that question as I use bleach / harpic ,in bathroom daily but I don't see connection towards T,and the door is always open when cleaning ,for ventilation .never had a breathing issue after using it.try alternative cleaner is what I'd do if made breathing a problem,don't keep using it.wont happen again.

 

But it happened the next day morning and I caughed a lot while cleaning. It did not start at that very time. I also coughed a lot while cleaning. ENTs don't agree with me. They say it's a news for us that bleach and Harpic can cause Tinnitus. Dear Marlene I keep cursing myself 24 hours a day that I did nt take care of my self and brought myself and my family in trouble. Each moment seems to be like an age. Every day I promise myself and them that I will be strong and try to fight but every moment I break it. I have ordered for a Neuromonics device and hopping that it works. You have T since 1996 how do you cope with it. I can't sleep don't have any hopes for good future. Want to relax and sleep. Alas I would nt have entered that wash room. I don't have any health problems as well. That is the only reason I presume.

 

Thanks Dr Hubbard for this uplifting story.

Can you please explain the difference between TRT and CBT as they both seem very equal.

Thanks.
Bart

 

Bart I would ask him this question in the "doctors corner" section
That might be more direct

 

Thanks Dr. Hubbard, for the uplifting story. I have had T and PT for the last 4 and half years. I am mostly habituated to the T, but the PT is ever present and extremely hard to ignore - I only don't notice it when my brain is busy somewhere else e.g. good movie, deep conversation. This has made sleep extremely difficult. Last summer, my doctor prescribed mindfulness meditation for me as I kept landing in her office freaking out because I couldn't sleep, and I won't take her pills. I have found since then that the MM (no CBT component) shifts something in my brain so that I am not struggling with sleep nearly as much (I'm afraid to jinx it by talking about it!). Having said that, I along with many others, continue to look for real solutions for the PT is particular, but also T. And I agree with the comment about research dollars going into MM, it's a coping mechanism, not a solution.

 

Dr. Hubbard: I am inspired by your success utilizing CBT and will now venture forward in finding a professional who has an established track record in helping those with tinnitus regain the silence with CBT. For me, I want a therapist who is not going to try out CBT with me out of curiousity but who is one who knows what they are doing. I am very serious about going forward with this. I have always been interested in mindfulness and all that it stands for and now I will be an active participant in learning about the strategies needed. Thank you Dr. Hubbard for your article/post and your story.