CBT (Cognitive Behavioral Therapy) for Hyperacusis

[Annika]

I have developed severe hyperacusis and moderate tinnitus since January this year. I have nearly completed a course of hyperacusis therapy based on CBT (this mainly involves changing my thoughts). After the first few sessions my therapist advised me not to use ear-protectors anymore and to expose myself to loud noises so that I can build up tolerance. Unfortunately, since I stopped wearing ear-protectors a few weeks ago my hearing sensitivity has deteriorated somewhat.

I have a couple of questions and would appreciate your advice.

1) The cause of hyperacusis seems to be a mystery. Could there be a physical element (i.e. damage to the mechanism of the inner ear)? Is it possible, that failing to protect oneself from loud sounds may inhibit a natural healing process?

2) Does anybody have experience of CBT for hyperacusis and did they found it helpful?

Thanks a lot,
Annika

 

[MindOverMatter]

Hello @Annika, sorry to hear about your condition.
I know how it is...
Hopefully, this will resolve one way or another over time.
Hyperacusis often tends to fade for many with time, and usually gets better before tinnitus.

Anyhow, it's all about protecting but not overprotecting. You should not expose yourself to loud sounds if not feeling comfortable with it. This is a slow process, and small steps have to be taken in order to reintroduce what before would be ordinary, everyday sounds. There will be minor setbacks, and normally a non-linear progression, but in time many people do get better.

I would advise to do counselling if you can connect with someone that's understanding, knowledgeable about this condition and emphatic. Personally I've found CBT helpful in this process, but it's no magic bullet. But you got a "tool box" that may be helpful in order to accept what is, for now, and overcome the fear and anxiety part of it.

 

[danielthor]

I think pretty much every report I've seen from people with severe hyperacusis on sound-exposure have been negative. I think, the lucky few who got better with sound-exposure did not get better because of sound-exposure, but despite of sound-exposure. They were able to handle it while resting and staying away from the sounds that they could not handle. These are moderate cases

I believe the damage is very physical, but with a psychological component. The physical damage will heal pretty quickly at first if given time to rest to heal, but then a lot of people don't actually know that they have healed and they stay reactive to sounds, causing pain. Some of them realize after exposing their ears slowly that it's psychological, and so they push through it and get better. But then there are those who've had multiple setbacks, whose ears are still damaged, and when they try to push through they get worse. The trick is to find out which one of these groups you belong to. Unfortunately there aren't any tests for this, so you will have to venture out and find out for yourself.

 

[ploughna]

What range of timelines are involved with potential improvement?

I'm 1 year in from the acoustic trauma that sent my previously mild tinnitus over the edge. Previously, it was stable, but now horribly unpredictable (never know what level the next day holds) and reactive to loud sounds along with hyperacusis that I'd describe more as very uncomfortable around loud sounds (no pain involved).

I'm trying to understand at what point is it as good as it's going to be.

 

[MindOverMatter]

@ploughna, you can still improve a lot.

I'm soon to be 2 year in after an acoustic trauma after 2 concerts with about 3 months in between. Which triggered it all. I've had tinnitus, which I was habituated to, for about 15 years before this happened.

Anyways, in general, I had the same symptoms as you + distortions at first, couldn't cope with pretty much any sound, dizziness, fullness in my ears. I was in a dark place for quite some time.

All was fueled by anxiety on top. It was really sort of like a post traumatic stress syndrome.

The hyperacusis/sound sensitivity and reactiveness in tinnitus still continues to improve. Actually, the first year, I didn't feel I had a lot of improvement at all. Probably was, but it's really hard to measure with fluctuating tinnitus on top of all this.

So yes, improvement can happen - even after a long time.

 

[Annika]

Hello @Annika, sorry to hear about your condition.
I know how it is...
Hopefully, this will resolve one way or another over time.
Hyperacusis often tends to fade for many with time, and usually gets better before tinnitus.

Anyhow, it's all about protecting but not overprotecting. You should not expose yourself to loud sounds if not feeling comfortable with it. This is a slow process, and small steps have to be taken in order to reintroduce what before would be ordinary, everyday sounds. There will be minor setbacks, and normally a non-linear progression, but in time many people do get better.

I would advise to do counselling if you can connect with someone that's understanding, knowledgeable about this condition and emphatic. Personally I've found CBT helpful in this process, but it's no magic bullet. But you got a "tool box" that may be helpful in order to accept what is, for now, and overcome the fear and anxiety part of it.

Hello MindOverMatter, thanks a lot for your support. I have been experiencing an unexpected setback with my hyperacusis. Your comments have been particularly helpful to me.

Thanks a lot,
Annika

 

[Annika]

I think pretty much every report I've seen from people with severe hyperacusis on sound-exposure have been negative. I think, the lucky few who got better with sound-exposure did not get better because of sound-exposure, but despite of sound-exposure. They were able to handle it while resting and staying away from the sounds that they could not handle. These are moderate cases

I believe the damage is very physical, but with a psychological component. The physical damage will heal pretty quickly at first if given time to rest to heal, but then a lot of people don't actually know that they have healed and they stay reactive to sounds, causing pain. Some of them realize after exposing their ears slowly that it's psychological, and so they push through it and get better. But then there are those who've had multiple setbacks, whose ears are still damaged, and when they try to push through they get worse. The trick is to find out which one of these groups you belong to. Unfortunately there aren't any tests for this, so you will have to venture out and find out for yourself.

Hello danielthor, thanks a lot for your support and sharing your knowledge. I have not figured it out yet but suspect I belong to the multiple setbacks group.

Many thanks,
Annika

 

[Taw]

@ploughna, you can still improve a lot.

I'm soon to be 2 year in after an acoustic trauma after 2 concerts with about 3 months in between. Which triggered it all. I've had tinnitus, which I was habituated to, for about 15 years before this happened.

Anyways, in general, I had the same symptoms as you + distortions at first, couldn't cope with pretty much any sound, dizziness, fullness in my ears. I was in a dark place for quite some time.

All was fueled by anxiety on top. It was really sort of like a post traumatic stress syndrome.

The hyperacusis/sound sensitivity and reactiveness in tinnitus still continues to improve. Actually, the first year, I didn't feel I had a lot of improvement at all. Probably was, but it's really hard to measure with fluctuating tinnitus on top of all this.

So yes, improvement can happen - even after a long time.

@MindOverMatter, I am glad that yours improved, this is great news.

Do you have loudness or pain hyperacusis? If pain hyperacusis, how long the pain lasts?

Thanks.

 

[MindOverMatter]

@Taw, I had/have loudness hyperacusis - with all that comes along with it: Fluttering, ear fullness, vibrating, buzzing, humming. Distortions, reactiveness, and a highly fluctuating tinnitus.

It just takes a lot of time and patience to get better. Personally I believe in adopting a positive mindset as well towards this condition. It's difficult, but not impossible. CBT makes a great tool in such an aspect.