Tinnitus: Cognitive Behavioral Therapy (CBT)

I just read an article about how if everyone with tinnitus would just focus on other things, besides our tinnitus, we can rewire our own brain and cure our tinnitus through deep breathing exercises.

It would be nice if it were true. Cognitive Behavioral Therapy (CBT) has been used successfully to relieve some tinnitus patients from feelings of despair and hopelessness that come with tinnitus grieving and flare ups. The treatment is helpful but it is not a cure. The treatment has to be practiced often to keep the negative emotions that come with tinnitus to a minimum.

People who claim that CBT cured tinnitus are likely people who have a depressive disorder. Naturally, if CBT works it will reduce the release of stress reactive serotonin associated with the disorder and reduce the tinnitus to a point that the brain can begin to ignore. There is no rewiring of the brain involved. It has to do with serotonin control.

There is a known grieving process over the idea of never having a quiet moment again. That grieving process can be shortened, for some people, by Cognitive Behavioral Therapy (CBT) and medication if necessary. Grieving can flare up with tinnitus flare ups. CBT helps tinnitus sufferers cope with the emotions associated with a flare up and recognize signs of grieving. Identifying the signs can help tinnitus sufferers to navigate the negative emotional waters until the flare up quiets down.

Wait, if CBT works for one tinnitus sufferer it should work for everyone with tinnitus...right? No. There is no treatment that works universally for everyone. There are various reasons why someone may have tinnitus such as cochlear cilia damage, mid-brain damage, traumatic brain injury, brain cancer, brain tumor, brain lesion, PTSD, Parkinson's disease, heat stroke, auditory nerve damage, Anti-NMDA receptor encephalitis, and serotonin syndrome for starters.

I believe that the threshold for whether CBT could work would be if the internal sound is below 85 decibels (with no brain damage). If the tinnitus is above 85 decibels, for long durations, I don't believe that Cognitive Behavioral Therapy would work. At that point the sound is nearly impossible to ignore without performance declination and or sleep deprivation. At that point anti-depressive and sleep medications may be necessary. Also, if there is physical damage to the pre-frontal cortex and the mid-brain (as in the case of a car accident survivor) the tinnitus patient may not be physically able to ignore the internal sound.

I also believe that it is cruel to try to convince a severe tinnitus sufferer (above the 85 decibels threshold) that he or she can cure the tinnitus through CBT. As I've often said, each of us has our own unique tinnitus. We may share the same types of internal noise but the underlying reason as to why we have tinnitus varies. This is why the treatment regimen for each tinnitus patient is so variable. No treatment works for everyone, yet.

I never discount a treatment. I never discount a testimonial. I encourage other tinnitus sufferers to try anything and everything that his or her individual treatment team recommends. Cognitive Behavioral Therapy may be one of the many suggested treatments to try. If a treatment doesn't work then move on. Not every treatment recommendation is going to work. The goal is to manage the tinnitus.

One problem is that a treatment provider can become so fixated and convinced that a certain treatment, like CBT, works universally for everyone that he or she can cause stress for the patient who communicates that the treatment is not working.

No treatment provider, who is practicing Cognitive Behavioral Therapy on tinnitus patients, really wants to hear that the treatment is not working. Some treatment providers may go so far as to insist that the treatment does work universally and that the patient needs to just try harder. That is like telling a patient with no eyes to just focus on something else, other than the blindness, and breath deeply and soon he or she will be able to see better.

No treatment provider should tell a tinnitus patient that has serotonin syndrome or pre-frontal cortex damage to try harder. The stress of failure to achieve the desired result of the treatment provider can cause excess serotonin to be released from the mid-brain of the patient which could cause a chain reaction of toxic dispersion throughout the patient's body which could lead to worsening of the underlying condition and even development of other multiple health conditions.

Providers and patients should accept when a treatment is not working and move on to something else. Accept what does not work and find out what does work for the individual patient.

Tinnitus: Coping with Christmas

Christmas can be a joyous time of year spent with friends and family. It can also be very annoying for people who suffer from chronic severe subjective tinnitus and hyperacusis. It isn't your fault that Aunt Ethel talks in a high pitched voice that causes your tinnitus to flare up. But what can you do? You don't want to be rude and offend her by asking her to tone down her voice.

Christmas choirs, bells, music, crowd noise, delivery trucks, buses, kids crying in the mall, even the tearing open of wrapping paper can all annoy hyperacusis and tinnitus sufferers to the point of experiencing anxiety. We want to flee to a quieter area. Why? It isn't because we don't love Aunt Ethel, it is because the sound of her voice causes our ears to amplify her voice louder and above what is normal. The amplification can cause the tinnitus to flare up. It is the ear and the brain that is the problem not the relative.

You can avoid all of that. Purchase some high quality Bose noise cancellation headphones and you may be able to cancel the annoying part of Aunt Ethel's voice and yet still hear her. The headphones are pricey but well worth the price.