The Psychology of Tinnitus. A guest post by Dr James Jackson

I suspect you might be surprised if I said that psychologists such as myself have a part to play in better understanding tinnitus. Why would that be? After all, as a ringing sound in your ears, and a sound not caused by external stimuli, tinnitus is an ear condition, isn’t it?

Well, no, not really.

Tinnitus is caused by an underlying condition, perhaps age-related hearing loss, exposure to noise, impacted earwax, a middle ear infection – all kinds of things. But rather than the perception of noise, psychologists are interested in how much attention is paid to that noise.

For example, if you are reading this and a lion walks into the room, then no matter how interesting this article may be, you will stop attending to it and you will attend to the lion instead. As I tell my students, the brain orientates towards threat. We have evolved to focus on the threatening and the unpleasant as these are the dangerous things in the world around us.

I have tinnitus, and I have a severe hearing loss, much of which happened when I was eighteen. But when I was younger, through measles of all things, I still had some hearing loss in one ear. I also had tinnitus, though I didn’t know what tinnitus was, and I assumed everyone heard the same noises I heard. When my catastrophic bilateral hearing loss struck in my first few weeks at university, I was hospitalised. Though great efforts were made, my hearing could not be saved. And while I was there, I was asked “Do you have tinnitus?”. I had to ask what tinnitus was, learning that the noises I had inside my head ought not to be there. I woke up the next morning and my tinnitus was truly awful. I’d go as far as saying that the majority of my twenties was actively ruined by my tinnitus. It had gone from being a neutral companion to being an invader, and it had done so overnight. I had gone to bed one night and my tinnitus was fine. I had woken up the next morning and it had become, at best, ‘life-changing’.

But what had changed?

It did not sound different – I have a number of tinnitus noises: An old-style TV test card sound, WW2 bombers roaring overhead, an out-of-tune oboe, etc. All competing for my attention. ‘It’ had not changed. Instead, I had changed.

Or to be more accurate, my appraisal of my tinnitus had changed, and on a subconscious and emotional level, I was paying more attention to it than I had previously. So started the most challenging years of my life – anxiety, depression, heavy drinking, sleep issues. The lot. But I returned to University, undertaking a BSc (hons) Psychology degree, then an MSc and finally, a PhD. For the latter, I was able to pick my topic. I choose tinnitus, and grew to understand the condition much more, even as I slowly habituated to it. This is key, as the tinnitus literature shows that any tinnitus intervention needs to have an educational component – what is tinnitus, and how does it affect others?

If a change in individual appraisal can make tinnitus worse, it also follows that a change in tinnitus appraisal can make tinnitus better.

This is the concept that enables psychological interventions for tinnitus to work, and to be effective. I still have my tinnitus. It has not gone away. It’s still there, but I don’t pay attention to it anymore. I have habituated. If I can, you can too.

Post-COVID, my research has looked at online Mindfulness-based interventions for tinnitus. Our Aim: to reduce anxiety and distress, whatever your postcode. When these are reduced, the brain is less likely to cast around for threats to attend to. It’s not that you ignore your tinnitus. Instead, you get to choose what to focus on and it can be something else. Mindfulness isn’t for everyone, but within eight weeks, it’s perfectly possible to see clinically significant reductions in tinnitus distress (not just a dip, but a meaningful reduction) in roughly 30-35% of a sample population. Some 15% of the sample drop out (as it’s not for them), whereas others take longer than eight weeks to gain advantage. Like many tinnitus interventions, it doesn’t work for everyone, but it needs to be pointed out that relatively cheap, easily-accessed therapies are out there, and when backed up by scientific evidence, are perfectly capable of enabling you to live your best life. A best life in which you are not stressed, and not constantly seeking out threats to attend to. Maybe Mindfulness is not for you – though more active forms such as Mindful Walking and Mindful Dancing work well for those people who like to move around and are not content to just lie there and relax (or for whom this is just too hard to manage when distressed). Walking your dog counts if you do it right. Other therapies/interventions exist too. What’s important is that you get out there and try them. Perhaps a self-help group run by Tinnitus UK, where you can speak with peers and learn you are not alone in this. Perhaps something else. But if you are trying something methodologically sound, you have chosen to not be a victim of tinnitus. This is the first step to taking back control of your life, and moving towards tinnitus habituation.

With thanks to audiologist Sally Jackson at Hearing and Tinnitus for this wonderful guest blog post. For more interesting articles about hearing and tinnitus, check out her website.