Learning to accept tinnitus

In this article, Hashir Aazh and Brian C.J. Moore, authors of Living Well with Tinnitus, describe some of the common experiences and feelings of people who are distressed by tinnitus and who have not yet embarked on CBT (which is proven to help). Your own experiences and feelings may be similar to or more or less severe than those described below. 

Many of us may believe that it is only natural to experience feelings of anxiety, sadness and irritation if our head is buzzing day and night, non-stop. Even if the tinnitus did stop at times, this would not count as a real relief, because it could come back at any time. We may think of tinnitus as a little beast, sitting on our shoulder, waiting to steal our happiness, weaken us, make us irascible, a person that we do not want to be and, last but not least, trying to steal our hopes of a satisfying life, of achieving our goals, of being helpful to others and simply of being normal. 

Perhaps our tinnitus gives us an excuse not to achieve all the things that we have aspired to do. That makes us feel even more disappointed in ourselves. What effects do people expect tinnitus to have? Perhaps they expect annoyance, and a sense of failure, unfairness and isolation. With tinnitus, how can we enjoy normal day-to-day activities or get any work done? How can we get enough sleep and remain healthy? Many people, even those with no experience of tinnitus, would agree that if they were hearing an unpleasant noise hissing away in their ears, they would go crazy. 

To make matters worse, very often tinnitus can be perceived as stopping us from hearing external sounds. We may feel that they have to pass through the barrier of tinnitus in order to be heard, and that tinnitus makes it harder for us to communicate with others. 

The terrorising fear of what might happen if tinnitus gets worse often casts a gloomy shadow over all aspects of our life. We may feel obliged to avoid certain activities, foods or environments and sometimes the fear limits our life far more than the tinnitus itself. The more we change our life because of tinnitus, the more important the tinnitus becomes. Even seemingly harmless forms of avoidance and rituals like playing music in the background to take our mind off tinnitus and help us to sleep, listening to noise to take the edge off our tinnitus or searching the Internet for a cure, can make us believe that tinnitus is tolerable only if we behave in a certain way. Perhaps these behaviours can make us feel reassured in the short term that there is something that we can do to gain control. But we remain fearful about what might happen in the future if these remedies stop working, which is often the case with avoidance behaviours and rituals. Certain strategies that we might think are helpful can in fact be counterproductive. 

Of course we want to get out of this vicious cycle; we want to be able to lead a normal life despite the tinnitus. But often we may feel stuck. We may feel that tinnitus is sapping our motivation, vitality and joy of life. We may develop resentment toward ourselves. We may feel disappointed that we have failed to get over these problems. We may feel that we are letting ourselves, our family or friends down. We may feel guilty for letting tinnitus impose a strain on our relationships with our spouses, children, parents, friends and colleagues. All this can snowball into a sense of worthlessness and failure. 

Often, we do our best to keep our motivation high and try to distract ourselves from tinnitus as much as we can. This can give us a sense of control and perhaps a sense of normality, because whenever we are fully engaged in an activity, we may not notice our tinnitus. But after a while we may feel exhausted with constantly trying to be fully engaged with a task. Every time that we are not distracted from the tinnitus, we may feel even more disappointed that we are still hearing it and there is no sign of progress. 

Sometimes we may feel that it was our own fault that we developed tinnitus. Perhaps we should have been more careful to protect our ears. Or we may feel angry at others if tinnitus somehow developed following their actions (or lack of action), for example, if it was the result of an accident, a medical procedure/treatment or a failure to diagnose and treat the underlying cause. One common fear is that tinnitus is a sign of a more dangerous undiagnosed disease. These thoughts can lead us to engage in a crusade of finding out more about tinnitus and the Holy Grail of a tinnitus cure. Such a crusade can drain our resources and time, somehow becoming a ritual in the form of information and reassurance seeking. 

Tinnitus sometimes sounds like musical tunes or muffled speech. When we have this kind of tinnitus, it can make us believe that we have a mental illness. But at least part of the problem is not with the tinnitus itself but rather with our thoughts about it. Perhaps if we could change our thoughts about tinnitus, our experience of it might also change. Learning about the mechanisms by which our thoughts are formed can help us to get closer to dealing with them in a more constructive way. Our reaction in terms of wanting to get rid of tinnitus, or avoid it if the former is not possible, is quite natural. But could this natural reaction lead to worse outcomes? What our instinct seems to be telling us may not always be helpful. Although we may think that avoidance techniques are the only solution, these can prevent us from learning how to manage tinnitus without being dependent on them. 

Sometimes, we may wish that our tinnitus was softer or had a different quality so that we could better accept it. But that does not seem to be feasible. How can we accept tinnitus as it is? Would that mean that we were simply accepting defeat? Could such acceptance actually facilitate a change in our experience of it? Perhaps the key point is that we need to accept ourselves as who we are, even when our tinnitus is at its worst. By doing so, we may remove barriers from the path of recovery and become the person that we want to be. 

What if the solution is not to feel better? Maybe we should feel the agony, anxiety and sadness. Maybe by doing so we would improve our tolerance for the uncomfortable feelings that tinnitus might cause. After all, these emotions and negative feelings are common and inevitable during our daily life. There will always be things that make us feel anxious, angry or depressed. If that is the case, and these emotions are unavoidable, then it might make sense to improve our tolerance of them. What benefit might we achieve by simply accepting the negative emotions that tinnitus can cause? Annoyance, irritation and sadness are also part of the boxing match if we want to learn how to beat tinnitus. If we throw our best punches as soon as the match starts, in the fear of being hurt, then we may not achieve the best outcome. It is not possible to give of our best if we are thinking of avoiding pain. Even if we want to avoid pain, we will still feel it. Perhaps the only way out is through! 

There are many factors we need to take into account for the successful management of tinnitus. The treatment should:

• give relief from tinnitus distress
• be lasting
• not be based on false hope
• depend on a change from within the person
• provide the opportunity to flourish and be a more resilient and confident human being

Think of it in this way. If we ranked ourselves as ‘1’ before tinnitus, and tinnitus made us ‘minus 1’, we should not settle for ‘0’ or even ‘1’. When we go through the marathon of tinnitus management, we should emerge as ‘1 plus’, a better version of ourselves than we were before the tinnitus! 

In the harsh landscape of tinnitus management, there will be several mountains to climb and marathons to run before we fully learn what we need to do. There will be punches that we need to take, pain to tolerate and tiredness to endure. There may be sadness, anger and irritation that we need to feel before happiness, pleasure and delight emerge. As the saying goes, no pain no gain! But the good news is that CBT techniques can empower us to move forward, should we choose to do so.