CBT and Tinnitus — I Don't Understand

[KingRoanoke]

Hello, I will make this post short. I've have tinnitus for several years and am not doing so hot, though I am better than I was when I first got it.

How exactly does CBT help you with tinnitus? You have a loud, painful noise in your head that you perceive all the time. What exactly in CBT is helpful? From my understanding, you're supposed to examine your emotions - but if something is objectively painful and intrusive, how do you convince yourself that you're going to be okay? I'm sorry, but I cannot convince myself of something that has several years of evidence to the contrary. Things are not okay.


EDIT: Also, this goes for any therapy that asserts some therapeutic element. In TRT, I was told all the tenets of habituation. I try to believe them, but then I live every day with this pain. How do you convince yourself otherwise? I did TRT and had the noise generators. I admit that I didn't use them for long. I just don't think it matters, in the end.

 

[cullenbohannon]

Hey man very sorry you're doing so bad. I'm no doctor but before I attempt to answer your questions I have a few for you. Have you ever went through these therapies? You refer to learning the tenets of TRT. Also the pain I want to say is possibly tempor tympani syndrome or some sound sensitivity. I haven't heard of t causing physical pain so can you elaborate a bit. Don't worry about keeping things short, let us know what you are going through we be able to help you better. If the pain is one of the things I mentioned there are ways of dealing with those to but I don't think anyone here can give you the advice of an experienced clinician who had helped people deal with t time and time again.

Hello, I will make this post short. I've have tinnitus for several years and am not doing so hot, though I am better than I was when I first got it.

How exactly does CBT help you with tinnitus? You have a loud, painful noise in your head that you perceive all the time. What exactly in CBT is helpful? From my understanding, you're supposed to examine your emotions - but if something is objectively painful and intrusive, how do you convince yourself that you're going to be okay? I'm sorry, but I cannot convince myself of something that has several years of evidence to the contrary. Things are not okay.


EDIT: Also, this goes for any therapy that asserts some therapeutic element. In TRT, I was told all the tenets of habituation. I try to believe them, but then I live every day with this pain. How do you convince yourself otherwise? I did TRT and had the noise generators. I admit that I didn't use them for long. I just don't think it matters, in the end.

 

[KingRoanoke]

Thanks for the reply. Yes, I've done TRT - but I didn't wear the generators for very long. Maybe about a week. I just didn't believe in them. I thought it was voodoo to listen to white noise all day and have this painful tinnitus just magically be benign. I am willing to give it another try, as they did cost me a lot of money. I know TRT has worked for a lot of people, so I don't bash it. And I admit that the noise generators are part of the protocol, so I haven't given the protocol a fair shot.

Tensor Tympani has been ruled out. It's a pain I feel when I hear the noise. It can be a "phantom" pain, for all I know. Maybe it isn't pain, but a very awful reaction to the noise. After years of this, I still don't know much about this condition. There are times when I'm in an environment with a lot of ambient noise and I don't hear my tinnitus, and I don't feel pain. I think that this feeling of pain could be my reaction to it, but then again, it could be the tinnitus itself. I don't know much except that it's just an unpleasant feeling.


Maybe I am just overly sensitive or have a low threshold for discomfort. I know that many people have tinnitus and don't care. I don't know why I can't just live with it like they do.

 

[Kathi]

Hello, I will make this post short. I've have tinnitus for several years and am not doing so hot, though I am better than I was when I first got it.

How exactly does CBT help you with tinnitus? You have a loud, painful noise in your head that you perceive all the time. What exactly in CBT is helpful? From my understanding, you're supposed to examine your emotions - but if something is objectively painful and intrusive, how do you convince yourself that you're going to be okay? I'm sorry, but I cannot convince myself of something that has several years of evidence to the contrary. Things are not okay.


EDIT: Also, this goes for any therapy that asserts some therapeutic element. In TRT, I was told all the tenets of habituation. I try to believe them, but then I live every day with this pain. How do you convince yourself otherwise? I did TRT and had the noise generators. I admit that I didn't use them for long. I just don't think it matters, in the end.

I'm sorry you're doing badly. CBT helps with my anxiety and that helps with my tinnitus. The relaxation helps with sleep and that helps my anxiety and tinnitus too. There is a strong correlation between anxiety and tinnitus.

It's not so much looking at our emotions as it is looking at the relationship of our thoughts to our emotions. Sometimes the way we think causes us to have distorted thoughts which lead to distorted emotions and fear/anxiety--which maintains a negative reaction to our tinnitus. I took an 'anxiety toolkit' class every Monday for six weeks and then saw my therapist every week but now it's every other week. I learned about relaxation and meditation. I do both twice a day, along with self hypnosis. I learned how to work on changing my way of thinking. I am working on desensitizing myself to my tinnitus. I'm still learning and just talking to a professional who is compassionate and caring helps too. I've been anxious most of my life and I had three life altering events in three years combined with an age related hearing loss--it may have been the perfect storm for tinnitus but no one really knows why some get it and some don't. I don't have any pain though, except occasional head aches in my left temple. Have you had and MRI or Cat Scan of your brain and auditory canals?

I'm so much better than I was in the first four/five months. It's a combination of things--medication, CBT, this support forum and the lovely people here. I think CBT is a big help but you should talk to a professional as not all therapies are for everyone. I hope you do better soon and I hope I answered your question. You might go to the Dr.'s corner and ask Dr. Nagler.

 

[KingRoanoke]

Maybe this is circular logic, but I don't think my thoughts are distorted. I have tinnitus that feels bad and my feelings about it are confirmed by it feeling bad. I cannot say to myself, "This isn't so bad" or "my thoughts are making this bad" because it is the tinnitus itself that hurts. I don't know. I think I'm going to try to go to bed. I am all riled up tonight, and maybe I need to collect my thoughts before I post any more.

Thank you for the reply, though. You sound like a very resilient and strong person.

 

[Snake Plissken]

Tinnitus is not "intrinsically bad". It is often compared to pain, but that's not really a valid comparison, because pain can be an indication of something seriously wrong. Except in a few rare cases, tinnitus is never a sign of anything seriously wrong. Simply because something feels bad doesn't mean that it IS bad. Your thinking IS circular logic. You are basically saying that it feels bad because it feels bad. If it evoked no reaction then you would not feel bad.

 

[cullenbohannon]

From what I read when you say sometimes in enviormnet with much ambient noise you don't hear it and no pain so I do think it's your reaction. After years of reacting negatively to it you may have reinforced that idea in your mind that it is bad and painful. If this is true, things like cbt and TRT done by experienced clinicians who deal with t. The idea is to stop associating that reaction and negative thoughts to t. I think over the years the has gained a
stronger hold on you but you should still
have hope. We have a ddr on here who used TRT and it took him over a year I belive for him to get better so it does take work. But it is not voodoo. I have taken some psychology classes in college and a lot of the things they sound like voodoo but
these things work, the studies I've read
about TRT usually 80+ percent of people start to get better . If you paid for TRT and I would try it what's the worse thiat could happen? It's better to try different things and see what works. I know I would be
willing to pay whatever to get my life better
or back. @Dr.Nagler going to post a answer about TRT soon so we can all get a better understanding of TRT him and @here2help could give you some good advice. They have been extremely helpful to me.
Also don't compare yourself to others on
your journey to recovery sometimes it takes longer, so in my mind we have two choices since no cure exists we can do whatever we have to in order to habituate or we suffer. I know you don't like how you're feeling now and there is a way out.

Also your cbt question might be one to pose on the doctors corner to @Dr.Hubbard

 

[KingRoanoke]

Thanks for the responses. I was having a bad night. I have calmed down. I woke up and my brain took a little time to find the tinnitus, but before that time I felt no pain. That does seem like it's probably my reaction - even after all these years, I must still have this bad reaction to it. But when I *find* the tinnitus, and spend all day working (albeit, in a quiet environment..I know, I know..) I am combating it all day. In that scenario, I forget that I'm just reacting to it, even though, I'm not conscious of it. It really does seem like it's just the way tinnitus is - especially because I've been fighting it for years. But I have to remember the reaction thing. I need a big change. I will go back to the noise generators, I think.

Yes, I'm familiar with Dr. Nagler and his story. He is a hell of a person. When I first got this, I was lucky to have read some of his literature. Saved my life.

 

[cullenbohannon]

Did you or do you have had counseling with your TRT. It seems to be one of the most important parts of TRT. I'm glad you will give it another go use the generators when you need to.

Thanks for the responses. I was having a bad night. I have calmed down. I woke up and my brain took a little time to find the tinnitus, but before that time I felt no pain. That does seem like it's probably my reaction - even after all these years, I must still have this bad reaction to it. But when I *find* the tinnitus, and spend all day working (albeit, in a quiet environment..I know, I know..) I am combating it all day. In that scenario, I forget that I'm just reacting to it, even though, I'm not conscious of it. It really does seem like it's just the way tinnitus is - especially because I've been fighting it for years. But I have to remember the reaction thing. I need a big change. I will go back to the noise generators, I think.

Yes, I'm familiar with Dr. Nagler and his story. He is a hell of a person. When I first got this, I was lucky to have read some of his literature. Saved my life.

 

[KingRoanoke]

Did you or do you have had counseling with your TRT. It seems to be one of the most important parts of TRT. I'm glad you will give it another go use the generators when you need to.

Yes I did have the counselling by a very competent clinician. I know all there is to know about habituation, I think. However, I did spend a lot of time on message boards that promoted "negative counseling" - which I probably could've done without. Ultimately, I don't think I bought into all of TRT because I couldn't get myself to believe something so aversive and painful could be benign. I want to believe it, but I feel as though my feelings are a testament to the contrary - and those feelings are stronger than any hopeful sentiment. What I need to stop doing is working in the quiet. I have cherished silence and quiet for as long as I can remember. In fact, most of my life has been lived in the quiet - because I had a preference for it. I have to relearn how to live with ambient noise if I can stand a chance against this.

 

[cullenbohannon]

I do think not buying into the philosophy can make it harder. In Dr.Naglers letter to a t sufferer he makes a great analogy about someone poking you and how you react differently when you think it's a gun and an umbrella. I do think we give tinnitus it's power and we can take it back. As a kid I remember being afraid of the dark, and as I grew older it didn't have the same affect on me. Of course t is way more intrusive and difficult then that but if we feed the monster it will grow. Stop feeding it and it shrinks. It will be difficult but many people have made it out from where you are. I hope you continue to stay on this board it's mostly very inspiring and not really any horror stories. Good luck and if you need to talk or anything else you can pm me anytime.

Yes I did have the counselling by a very competent clinician. I know all there is to know about habituation, I think. However, I did spend a lot of time on message boards that promoted "negative counseling" - which I probably could've done without. Ultimately, I don't think I bought into all of TRT because I couldn't get myself to believe something so aversive and painful could be benign. I want to believe it, but I feel as though my feelings are a testament to the contrary - and those feelings are stronger than any hopeful sentiment. What I need to stop doing is working in the quiet. I have cherished silence and quiet for as long as I can remember. In fact, most of my life has been lived in the quiet - because I had a preference for it. I have to relearn how to live with ambient noise if I can stand a chance against this.

 

[Mark McDill]

I would echo @cullenbohannon; it's about your reaction to it. I don't like my T and I, too, think it is a negative thing (if not downright weird); but I don't react to it anymore (or very little). It doesn't mean I like it (I really don't) and all things being equal I would put it in a capsule send it to sun in a heartbeat (if I could) -- but I don't react to it. I figure T is like the bad neighbors that live down the street; the less you interact with them the better off you are.

It sounds like you may wrestle with the same thing I do. About 8-9 months into T I realized that I struggle with the idea of T far more (now) than the actual T. It's the idea that gets to me more than the sound.

 

[cullenbohannon]

Another thing I will add the first two weeks I had t, it did not bother me in the least. I still studied and concentrated on everything I did before. Then one day I realized it wasn't just going to go away.
That's when the panic anxiety fear took over. I took lots of xanax and did what most people do when trying to get better. I just think it's interesting how my reaction changed from one end of the spectrum to the other so fast and harshly.

 

[Mark McDill]

@cullenbohannon ; that's spot on! I reacted the same way (wish I could go back and NOT react).

 

[Littlebailey]

Another thing I will add the first two weeks I had t, it did not bother me in the least. I still studied and concentrated on everything I did before. Then one day I realized it wasn't just going to go away.
That's when the panic anxiety fear took over. I took lots of xanax and did what most people do when trying to get better. I just think it's interesting how my reaction changed from one end of the spectrum to the other so fast and harshly.

Wow, I'm exactly like you, the first few days to a week I was pretty cool with it. The first couple of nights I slept a full night's sleep. It wasn't very loud, still isn't. But then it sets in that it could be permanent, and that's when you start to panic, and the anxiety kicks up. And my T really does seem to go hand in hand with the way I'm feeling. It can get real quiet when I'm cool, and louder when I'm not. But I understand yours was/is fairly loud? That's great that you never broke stride, at least until you actually stepped back and contemplated it. Of course you're going to be healed pretty soon!

When you took Xanax did it subside much?

 

[cullenbohannon]

LB with xanax it made me very relaxed and I did not pay attention to it much. My perception of it was greatly reduced. It was very helpful for me

Wow, I'm exactly like you, the first few days to a week I was pretty cool with it. The first couple of nights I slept a full night's sleep. It wasn't very loud, still isn't. But then it sets in that it could be permanent, and that's when you start to panic, and the anxiety kicks up. And my T really does seem to go hand in hand with the way I'm feeling. It can get real quiet when I'm cool, and louder when I'm not. But I understand yours was/is fairly loud? That's great that you never broke stride, at least until you actually stepped back and contemplated it. Of course you're going to be healed pretty soon!

When you took Xanax did it subside much?

 

[Kathi]

I was like you Cullen, at first. I had a hissing sound and it was freaky but I managed to go to work on Thursday and Friday and sleep at night. It was when it didn't go away in 5 days and then after the visit to the ENT that I went off the deep end. He told me it was something that I was doing, combined with my age related HF hearing loss that was causing the T! That I was the problem! Well it got louder and I tried to go it alone for almost a month, sleeping 2-3 hours a night and then the panic attacks started...I found my way here and my GP gave me some ambien for a week and then some Xanax. The Xanax really helped reduce my perception as well as chill me out long enough to figure out a strategy.

 

[cullenbohannon]

Hey Kathi my t was actually louder at the begining and got lower after.

I was like you Cullen, at first. I had a hissing sound and it was freaky but I managed to go to work on Thursday and Friday and sleep at night. It was when it didn't go away in 5 days and then after the visit to the ENT that I went off the deep end. He told me it was something that I was doing, combined with my age related HF hearing loss that was causing the T! That I was the problem! Well it got louder and I tried to go it alone for almost a month, sleeping 2-3 hours a night and then the panic attacks started...I found my way here and my GP gave me some ambien for a week and then some Xanax. The Xanax really helped reduce my perception as well as chill me out long enough to figure out a strategy.

 

[Kathi]

Hi @cullenbohannon --my T is low now on some days but loud on others. It is not consistent. It seems to fluctuate.

 

[Dr. Nagler]

Yes I did have the counselling by a very competent clinician.

Hi @KingRoanoke -

Your entire post #10 is very interesting to me, but especially the sentence I quoted above.

What was it about your TRT clinician that led you to conclude that he or she was "very competent." I mean, there is no certification or standardization in TRT. So what leads you to believe that your TRT clinician knew his or her aspic from a hole in the wall?

Stephen Nagler

 

[KingRoanoke]

Well, I had read Jastreboff's book (TRT: Implementing the Neurophysiological Model) as well as any and all literature I could find on habituation - and she knew her stuff.

She was a good communicator and had tinnitus herself, and seemed to be living fine with it. I guess I cannot objectively know. It's all intuition.

 

[Dr. Nagler]

@KingRoanoke -

Thanks for your excellent response. The lack of credentialing and standardization in TRT is a huge issue for me. (I hasten to add that TRT is not alone in that regard.)

FWIW you don't have to "buy into" TRT for it to be effective. But that's a story for another day.

Stephen Nagler

 

[Magpie]

King Raonoke wrote:
Thanks for the responses. I was having a bad night. I have calmed down. I woke up and my brain took a little time to find the tinnitus, but before that time I felt no pain. That does seem like it's probably my reaction - even after all these years, I must still have this bad reaction to it. But when I *find* the tinnitus, and spend all day working (albeit, in a quiet environment..I know, I know..) I am combating it all day. In that scenario, I forget that I'm just reacting to it, even though, I'm not conscious of it. It really does seem like it's just the way tinnitus is - especially because I've been fighting it for years. But I have to remember the reaction thing. I need a big change. I will go back to the noise generators, I think.

One day in the past I finally realised that it ain't gonna go away, get quieter, get cured or get anything else. Call it acceptance or whatever it don't matter but I just gave up the fight and figured it is what it is and there is nothing I can do. Sometimes it bugs me but most of the time it's there as it has been since day dot and I go about my business as if it wasn't there. Interesting reading your brain took a little time to find your tinnitus because my brain doesn't have to find it because it's there all the time. Very occasionally I am so involved in something stimulating and my T goes into the background and I'm not aware of it. If your brain can get enough stimulation it won't be aware of your tinnitus. You hit the nail on the head as far as reaction goes and in the end it's what matters.

 

[cowdodge]

Being busy with friends or anything seems to help me. I have Zen hearing aids and I believe they help me with my anxity as when the t's really start to blast oft I have a little control over it by adjusting to a louder sound. My personality is that I can talk to a perfect stranger and not feel ill at ease but I know this is just a way of controlling my situation. I have a book CBT FOR DUMMIES but it just seems so out of place for what I have. I'm waiting for approval from OWCP for approval to start a program of BIO FEEDBACK as my addtiologist stated to me that this can help me with me with my stress reaction to the t's. Any thoughts about her idea? Oh yes and least but not last I tend to get a little confussed with all the input here but I do try.