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Hey Joe I've worked with about 200 people, about 2/3 have improved (that's in line with the CBT studies). Those who improved haven't always specified the pitch so it's hard for me to determine who might have had low pitch who was helped by CBT. I don't see why CBT wouldn't help with low pitch...

Please view my webinar. It has a lot of info and helpful recommendations: www.cbtfortinnitus.com/webinar I do offer phone and vid sessions: https://www.cbtfortinnitus.com/cbt-coaching-sessions/

Hey Dub Sorry to hear this. Sucks to be stuck in headphones world w hearing loss and tinnitus. No huperacusis? Stress can bring out tendencies for emotional conditions and tinnitus can be stressful, but no reason to believe tinnitus itself will do so. Gerri g better w your response to tinnitus...

Thank you for your kind words!

Thank you Billie48! From Darkness to Light is a terrific success story, and clearly of great help to people struggling with tinnitus and hyperacusis. Your approach to recovery is very much like what we do in Cognitive Behavioral Therapy (CBT). It proves that the best strategies draw on age-old...

Hey Joey Not surprised to hear that. There are very few qualified CBT therapists in the US who understand tinnitus, and I don't know anyone in Columbus. Yes, you can call and ask. Asking them what they've read on CBT for tinnitus is a good way to test if they're legit. They would list names...

My tinnitus is pretty loud, and I haven't been bothered by it in 10 years. I believe the focus should be on helping people adapt and habituate and not wait for a cure.

Despite claims to the contrary, no one can predict what your tinnitus will do. Nor is there any sound biochemistry understanding of the causes of tinnitus. The good news is that you can learn to respond to tinnitus in a manner that moves it to the background, and eventually habituate and not...

Hi Jim I see you reached out to me by I can't access the post. Please try again. Dr Hubbard

Hey Tom Sure! I explored working with an audiologist, but saw the in ear devices as a last resort. I used external background sound strategically: when I was working at my desk, to help with concentration, and for sleep. Used it for about the first year, then tapered it off. Haven't used it...

I'd like to very respectfully weigh in here on Stephen Katz and his Cognitive Retraining Therapy. First, despite what he calls himself on his website, Mr. Katz is not a "doctor." He has a masters degree in social work. Second, his "cognitive retraining therapy" is absolutely not the Cognitive...

Hey Claudia, You've done well with OCD! Congratulations! And you appear to understand CBT well. The fact is, most people - around 98% - do eventually habituate to tinnitus. This fact is reassuring to many and helps them let go of their tinnitus. But given your OCD tendencies, if reassurance...

Hi Tigo Despite anecdotal reports, there is no scientifically derived evidence that medications like Paxil cause or worsen tinnitus. While tinnitus is sometimes listed as a side effect for medications, this has not been assessed in a rigorous manner. On the contrary, I have seen...

Dear Fosginn, My heart goes out to you. Right now, as so many of us do in the immediate aftermath of tinnitus onset (or, it seems in your case, a worsening of preexisting condition), you are, in CBT terms catastrophizing – grasping onto the worst case scenario as if it were written in stone...

Hi Barbara It might be helpful for you to know some facts about habituation: Habituation is a natural process in the brain that pertains to all areas of sensory stimulation. For example, chances are that right now you're not aware of the sensations of your body against your seat, your feet...

It's a great question but more than i can get into over a forum. And there are many good texts and instructional programs on learning mindfulness (e.g., Jon Kabat-Zin "Full Catastrophe Living"). In summary, mindfulness helps you learn to accept tinnitus emotionally. it also helps you let go and...

there are many self help books for CBT. The most recent that i would recommend is "Mind and Emotion" by Mathew McKay. There is also a self help CBT book for tinnitus - it's old and you'd need to find a used copy: How to Live with the Ringing in Your Ears by Hallam. I published an article in...

Hi Shasta that's what happens to me. i had low tinnitus (sounds like yours) and it suddenly got much louder. My story is about adapting to that louder level. I have habituated - i can hear it whenever i want to (clearly hear it in a car, over the hum of anything motors running in my home, etc)...

Hi Silvio there is a strong association between tinnitus and depression so I think your hypothesis is likely correct. Perception of tinnitus is such a subjective experience that it's difficult to really know sometimes if the volume is gradually increasing or the anxious, despairing attention we...

Hey Mark what a great story of recovery! Some cases of hyperacusis do appear to be made worse, if not caused, by avoidance of external sound. Avoidance is a natural, self protective survival mechanisms, especially if you believe that your tinnitus is triggered or affected by the normal levels...

Hey Mark yes, hiding from sound is the worst thing you can do with hyperacusis and reactive tinnitus. Consistent exposure, as tolerated, will promote desensitization. Best wishes DR Hubbard

Hey Chris that's a tough one, though i have heard it before. Sounds like your tinnitus is a "reactive" type. This is an informal description and seems to describe a subset of people with tinnitus. There's no research on this type of tinnitus so i'm speculating on what might help. So i would...

Hey Mike i'm not an MD and can't really address the neurochemistry, however, i will share with you that i only recommend SSRI and benzodiazapines (like Klonopin) when the anxiety and panic are so overwhelming that the person cannot focus on CBT like strategies. These include keeping your...

Yes Aldo, the same strategies used to help accept and habituate to tinnitus apply to sound distortion. The distortions were the scariest part for me as well. I occasionally notice them but without the fear and despair. Dr Hubbard

there's really not enough space here to go into the details of CBT for tinnitus, though it does draw from the treatments for anxiety which you are probably familiar with - keeping your thinking grounded, facing your fear by activating in valued directions. It's largely about cultivating...

Is there something specific your struggling with?

Here you go! These are some examples of "cognitive scripts" - phrases and statements intended to establish a healthy, effective perspective on tinnitus and your response to it. These scripts are used to ground thinking over the course of the day, redirect your attention away from tinnitus and...

Hi Stacey I'm hoping it's that the increased loudness of the tinnitus will resolve (back to it's usual level), in the same way your ears ring the day after a concert then go back to normal. You'd need to see an ENT about the steroids, but on the surface that's probably not indicated. Steroids...

Lisa, That's funny you ask as I've been putting together a list of phrases, statements to help redirect tinnitus sufferers in positive, effective directions. I will get that into shape tomorrow and post it then. best wishes! Dr Hubbard

Hi Ilija You're only a month in, so it's not possible to predict the course of your condition. Sounds like you may have some mild hyperacusis, but that is really a diagnosis for a qualified auidologist or otologist to make. It may resolve on it's own over the next few weeks, just as the tinnitus...

Again, does the volume change or just our perception of it? i think it's usually the later. There's no research I'm aware of tracking long term course of habituation, which generally occurs over the first 18 months. I know of only one case of tinnitus that literally "went away" after three...

Hi Lisa Sorry for the delayed reply. Because it's so hard to predict the course of tinnitus, and it varies so much from person to person, my advice is to take any steps helpful for habituating, and detach from any expectations of it going away. And yes, does it fade - as in the actual volume of...

Great question, Lisa! There's no research aware of on how benzos affect the pace of habituation. My clinical experience is that benzos, masking, and other attempts to artificially avoid T do slow the process. One approach then is to use these sparingly, every few days, when you are most...

Great point Jazz! In the absence of a cure, habituation - not thinking or caring about tinnitus - is the next best thing. So why doesn’t habituation occur naturally for a significant portion of tinnitus sufferers? Our brains have an emergency responses system triggered in the brain's limbic...

I'm sorry i can't speak to that. Perhaps an audiologist or otolaryngologist (ENT) might help.

Hey Ryan I wouldn't give up on habituation. What have you tried? CBT? TRT? MBCT? There are no scientific studies i'm aware of, but some clinical indication that SSRIs, like Prozac and Lexapro might help. Also some indication benzodiazepines like Ativan may have a chemical affect on tinnitus, or...

Hi Karen sorry for the late reply. I don't know of any CBT studies specifically addressing pulsitile tinnitus. I've had success helping with people with pulsitile. Once you've got a clear bill of health from your medical doctor, as you have, then CBT would precede as usual, with a focus on...

Dear LadyDi Thank you for providing me the opportunity to respond to this important question about CBT. First of all, congratulations to you and to your CBT therapist on your success to date. Anxiety and panic are common responses to tinnitus onset, and not easy to deal with, especially on top...

Hey Freddie You're correct that this is not my area of expertise. However, I have a suggestion you can ask your audiologist/ENT about. There is a category or tinnitus (in this case, better called "Head Noise") known as "mechanical" or "objective," that can be heard externally (through...

Hi Lisa Habituation is a natural neurological process in which the brain determines that a particular signal is not important and tunes it out of awareness. It occurs with all types of sensation (like touch, smell, vision). Tinnitus is such a signal, because it's not truly dangerous (even...

Hey All, I’d like to take some space here to describe contemporary CBT for tinnitus, as there are some misunderstandings expressed in this strand. (I apologize in advance for the length of this post!) First, CBT has evolved greatly over the past ten years. It’s no longer accurate to describe...

Hi Joan the translation was a little tricky. Most people habituate to tinnitus naturally, on their own, within about 12-18 months. Scientists believe that anxious attention to the sound slows that process down. CBT focuses on changing your relationship with the sound and activating fully in your...

You're right Jazz, habituation is about attention, but also the quality of attention you bring to tinnitus sounds. Mindfulness characterizes this quality, and is best understood as the “relationship” you have with tinnitus. What works best for promoting habituation is an open, accepting...

Hi Cassidy, My tinnitus is pretty stable. There are minor fluctuctuations which, over the first year, would reignite my anxious thinking. In looking back, i now believe this was largely a result of my hypervigilence (excessive anxious attention) to tinnitus, which reinforced the subjective...

Hey Cullenbohannon, Yes, according to the CBT model, state of mind can slow or even prevent habituation and adjustment to tinnitus. You can think of this as the relationship you have with your tinnitus: a resistant, fearful relationship, in which the person is constantly resenting and bracing...

Hi Carlos I know of Remeron as an antidepressant but have no experience with it as a treatment for tinnitus. If you try it, please be advised that Remeron is very sedating and should only be taken before bed. In fact, it is generally used as a combination sleep agent and antidepressant. Best...

Hi Telis As far as I am aware, there are no consistent ototoxic effects of antidepressants, and they can be very helpful in reducing anxiety. The most common variety are SSRIs (like Prozac and Lexapro). These may make it easier for you to adjust and habituate to tinnitus. If you can, find a...

Hey Gary, Though you certainly have had your share of it, stress itself is not a known cause of tinnitus. I love your spirit! Dr Hubbard

Hi Kathi Agreed! While there's no single medication that helps everyone with tinnitus, some medications seem to help some people. So if it's working, great! Glad you found something! Yes, habituation is a gradual process. You'll notice more and more that you're not thinking about tinnitus, and...

The most accurate answer is "I don't know." I am not a physician, and have limited knowledge of the impact of medications on the onset and course of tinnitus. I humbly refer you to Dr. Nagler, who I believe to be expert on this topic. In my opinion, if there are negative effects of...

There's no biochemical mechanisms by which lorazepam would intervene directly to reduce tinnitus. As you suggest, then, the most likely explanation is that lorazapam reduces anxiety, which reduces your hypervigilance to tinnitus. The result is that the perceived, or "subjective" volume of the...

Hey Matt, i see your question is a two-parter: While there is about an 80% overlap between anxiety and depressive symptoms, they can definitely occur independently. Depression is characterized by hopelessness, fatigue, anhedonia (reduction or complete loss of pleasure); anxiety is the anxious...

Hi Matt Great question! It's important to understand that emotions are normal brain responses to real hardships. The best medicine is to consistently change your behavior in a positive direction over time. However, there are steps we can take to sand the edge off anxiety in the moment that can...

Hey Freddie In addition to managing your emotional response through cognitive restructuring, and engaging in TRT, you can practice mindfulness of sound, including tinnitus sounds. Mindfulness both softens your experience of the sounds and provides exposure, an effective cognitive behavioral...

Hi Deb I'm sorry this has happened. There is hope that if the sound doesn't resolve, you will habituate. Time is on your side so be patient. The best thing you can do is to "get out of your head!" Tell yourself: "this is not important - the stuff of my life is what's important" and get to it...

Hi Steve, Self-help books, like "Feeling Good" and "Mind Over Mood," have helped make CBT available to the widest range of sufferers. I highly recommend CBT apps as the evolution of this self-help mission. CBT apps are interactive workbooks that provide valuable information and engage the user...

Dear Dr. Nagler, Around the time my tinnitus started, I began to experience auditory distortions and a nails-on-a-chalkboard-like inner ear sensation in response to sharp, high frequencies, loud noises, and booming bass. It seems that many people describe this experience as "hyperacusis."...

Thank you Dr. Nagler. I am honored to be among such esteemed company in the Doctors’ Corner! And thank you for bringing to light this common confusion over the many faces of CBT. The easy part: There is absolutely no difference between the terms "CBT", "Cognitive Behavior Therapy" and...

Thanks Jazz. As far as I'm aware, there is no evidence that CBT techniques applied to tinnitus distress result in reduction of true loudness of tinnitus sounds. However, this is not the goal of CBT. The goal of CBT is to reduce hypervigilence, that is, the anxious preoccupation with the sounds...

Thanks Gary. Unfortunately there are very few CBT therapists who are experienced in using the approach to help with intrusive tinnitus. I'm working to change that! in the meantime, i will check my network to see if i can find someone in Detroit who can help you.