Taming tinnitus - behavioural techniques

Taming tinnitus - behavioural techniques

Treatment and management of tinnitus

Dr Vickie House, Dr Laurence McKenna, Dr David Scott

Psychologists,The Royal Throat, Nose and Ear Hospital, London

January 2009

(Last updated on 13 April 2011)

Do you feel sometimes that your tinnitus is taking over? Many people do.

At times like this, it can be difficult to imagine that there are ways of turning the tables and managing your response to tinnitus.

Whilst there is currently no known ‘cure’ for tinnitus, there are a range of strategies that can help to minimise the intrusiveness of the noises.

People can and do manage the impact that tinnitus has on their lives.

Here are some ideas.

Making the tinnitus less ‘attention-grabbing’

Research shows that, whilst a large percentage of the population have tinnitus noises, a much smaller percentage are generally aware of them or distressed by them.

This is because people are often able to get used to the noises or ‘habituate’ to them – just as we can often get used to other noises around us (e.g. air conditioning or a clock ticking).

In general, the noises we are most able to ignore are predictable, repetitive sounds that we perceive as non-threatening, uninteresting, and unimportant.

We are also more able to direct what we pay attention to when we are more relaxed.

Here are some ideas for starving tinnitus of attention:

Do:

1.      Notice in which environments and during which activities the tinnitus is less noticeable.

2.      Try to do more of the activities that help to shift your attention from the tinnitus (these will probably be activities you enjoy or are interested in).

3.      Expect the noises to be more noticeable in some environments (e.g. where there is less background noise).

4.      If possible, try to find ways of sometimes making these environments less ‘tinnitus friendly’ (e.g. occasionally introducing some low-level sound).

5.      Be cautious not to use at all times, as avoiding tinnitus entirely can increase the distress response to tinnitus.

6.      Take some time each day to practice switching your attention between the tinnitus noises and other bodily sensations.

7.      For example, close your eyes and take a couple of minutes to focus on the rhythm of your breathing, then switch your attention to your hands and mentally count your fingers, refocus on your breathing, switch to monitoring your tinnitus noises, then focus on your breathing again.

8.      Notice how you are able to control your attention.

9.      Some people find that building their tinnitus into a non-stressful mental image can help to reduce the distress it causes.

10.  For example, if your tinnitus sounds like waves crashing, take some time each day to shut your eyes and picture a beach.

11.  If the tinnitus sounds like whistling, try to picture a kettle boiling.

12.  Practice slowing down your breathing and relaxing your muscles every day (perhaps try a warm bath, muscle relaxation exercises, or a massage).

13.   Tinnitus works a bit like an ‘emotional barometer’ – it is often more intrusive when there is stress or worry around.

14.  When you notice that the tinnitus is demanding your attention, ask yourself if there is anything else that is on your mind that you need to sort out.

15.  Having tinnitus does not make you immune to other worries and stresses – are you giving the tinnitus more credit for your stress than it deserves?

16.   Worries are often made worse by avoiding the thing we are worried about.

17.  For example, if you avoid activities because you are worried they may make your tinnitus worse, then you won’t discover, as most people do, that the tinnitus settles down afterwards.

18.  This means that you will remain worried about the tinnitus and you will feel unhappy because you are not doing what you want to do.

19.  So live your life in spite of the tinnitus, not because of it.

20.  Do things because you want to rather than because you think they will help to ward-off the tinnitus.

21.  By planning your life around the tinnitus, you are feeding it with attention, and it will only demand more and more.

22.  Advise those close to you of your quest to reduce the amount of attention your tinnitus receives.

23.  Explain why you are doing this and ask for support – perhaps suggest that they don’t ask you quite so often how your tinnitus is.

24.  Maybe they could help you to focus on other things.

Do not:

1.  Feed the tinnitus by putting your life on hold while you chase a ‘cure’.
2. There is no proven cure for tinnitus at this time – when there is, you’ll be sure to know about it!
3. Remember, though, this does not mean you have to be controlled by tinnitus.
4.  “Test’ your tinnitus – e.g. listening out for whether you can hear the tinnitus over the TV or trying to figure out whether the noises you are concentrating on are the tinnitus or your masker.
5. Each time you are ‘listening out’ for the tinnitus you are guiding your attention towards it.

Getting a decent night’s sleep

Many people with tinnitus believe that the noises disrupt their sleep.

If you have difficulty getting off to sleep it may be that the shift from a relatively noisy daytime environment to the quietness of the bedroom makes the tinnitus noises more noticeable – in the same way that a candle looks brightest in a dark room.

Some people find that having some low-level sound in the bedroom (e.g. wave sounds, a fan or calming music) can help to mask the tinnitus noises.

However, using sound that is too loud or attention-grabbing (e.g. rock music or listening to a talk programme on the radio) may get in the way of falling asleep.

It is also important to remember some general principles for promoting good sleep:

Do:

1.  Try to reduce your daily caffeine intake and to cut caffeine out completely in the evening.
2. Aim to get some exercise each day – but not too close to bedtime.
3.  Make time to move your head out of planning or worrying mode – before bedtime, spend a maximum of 10 minutes writing down ideas or issues you want to tackle tomorrow (but be realistic!)
4.  Make a point of winding down at least half an hour before going to bed (e.g. doing relaxation exercises, listening to soothing music).
5.  Go to bed when you feel tired rather than at a set-time. However, try to stick to a set-time for getting up each day.
6.   Try to get your brain used to thinking that bed = sleep by turning out the lights as soon as you get into bed.
7.  If you don’t get to sleep within 20 minutes of turning the lights out, don’t panic - get up, move to another room, and do something relaxing (but, again, not something that is going to grab your attention) until you begin to feel more tired. Then go back to bed.

Do not:

1.      Cat-nap in the daytime.

2.       Do anything mentally stimulating in your winding-down period before bed or when you go to bed, e.g. watching TV, doing crosswords or listening to talk programmes on the radio.

3.       Some people believe that their tinnitus wakes them up during the night.

4.      This, however, is unlikely to be the case.

5.      Sleep naturally goes in cycles broken up by brief periods of waking (although we often don’t remember being awake).

6.      When people feel that their tinnitus has woken them up, it is more likely that they have tuned into the tinnitus noises during one of their natural waking periods.

If you are having difficulty retuning to sleep after waking in the night:

Do:

1. ·        Try to restrict your alcohol intake. Alcohol can disrupt the natural sleep cycle.
2. ·         Try whispering a nonsense-word (e.g. ‘dah’) over and over – this may help to block out intrusive thoughts or worries.
3. ·         If you are awake for more than 20 minutes, try getting up, moving to another room, and doing something relaxing until you feel more tired.

Do not:

1.      Panic if you wake up. Your body will ensure you get the minimum sleep you need, but you can help it along by staying calm and relaxed.

Fuente: British Tinnitus Association

Helpline: 0800 018 0527

www.tinnitus.org.uk