There is one specific and important guiding principle to keep in mind when using Cognitive Behavioural Therapy for tinnitus:
Cognitive Behavioural Therapy is NOT a treatment for tinnitus! Cognitive Behavioural Therapy is a treatment for the DISTRESS that tinnitus causes.
Let me explain…. We can hear any noise (including tinnitus) and ignore it. We do this all the time: for example, when in a shopping mall, on a busy street, in a car, on the bus or train, even at home – inside or out: we can read a book or magazine while the tv is wittering on in the corner, or not notice the birds twittering when we are in the garden.
This isn’t true for absolutely every person on the planet in every situation! Some of us have developed a ‘sensitivity’ to noise – sometimes to any noises, sometimes to particular types of noise. Most of us, in fact, cringe at the scraping of nails down a blackboard (for those of us old enough to have been in school classrooms that even used blackboards!). And when we become aware we are in a situation where we might expect such a cringe-worthy noise to happen, our brain goes in to a vigilance state, whereby it anticipates that an offending noise may happen at any time. In a vigilance state, the brain – and indeed the body – go in to threat-mode. We don’t consciously decide to do this – it’s our subconscious that takes over and makes that decision.
This is where we are when we have tinnitus distress.
If we decide we don’t like the tinnitus, don’t want it, have negative feelings about it, predict good or bad days depending on “how loud” tinnitus is, we have unwittingly given the brain a reason for the subconscious to take over. These feelings are both sensations (feelings we can feel in our body like tensing up) and emotions (emotions like fear, anger, sadness, just to give three common examples). These feelings and emotions become ‘wired’ in to subconscious areas of the brain, and thus become a blueprint for how and what we think, how we behave and what we do. Internally (subconsciously for the most part), we create narratives (stories) around it all that emphasise, support and grow those negative feelings and emotions. We have given a ‘threat-meaning’ to the tinnitus; we believe our narratives and thus become someone with ‘‘tinnitus distress’’, rather than someone who “has tinnitus”.
Take the distress away, and we notice the tinnitus less; and even when we do notice it, we don’t care so there’s no reason to remember to think about it.
Cognitive Behavioural Therapy is re-training how and what we think, and how and what we do. It takes the distress away through enabling the blueprint we created earlier to change to a different blueprint – one where we have learned not to care whether tinnitus is there or not. We have removed the made-up threat we unwittingly created around having tinnitus.
NOTE: While it is true that a very high proportion of people experience a lowering in volume of their tinnitus by the time they have reached stages 4-6 (of the 12 stages) of the Tinnitus E-Programme process, this is due to the 'little and often, regular and consistent' use of short breathing exercises (2-3 minutes each time) and relaxation, so the change in loudness perception is more as a result of behavioural changes rather than cognition changes. CBT combines Behavioural as well as Cognitive therapy.