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!