When Silence Is Lost: How To Cope With Tinnitus

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It engulfs when the house is quiet. It can feel claustrophobic, the creeping sense that it is inescapable, and silence is forever lost.

In the UK, 1 in 10 people are affected by tinnitus (NICE, 2020). Those who experience tinnitus often describe how it affects every aspect of their lives.

Tinnitus is commonly described as a ringing in the ears, but it also can sound like roaring, clicking, hissing, or buzzing. It may be soft or loud, high pitched or low pitched.

NIDCD (2017)

Although the understanding of tinnitus has advanced in recent years, Dubey (2021) describes it as a "diagnosis of mystery...with no confirmed confirmed pathophysiological mechanism to explain the origin and no gold standard treatment". This provides little comfort to those who experience it.

The psychological impact of tinnitus

Many research studies show the detrimental impact tinnitus can have on a person's mental health. For example, anxiety and depression are common in those with tinnitus (NICE, 2020), and unsurprisingly people with tinnitus report lower quality of life and higher psychological distress (Boecking et al, 2021).

In an interesting study, Pryce and Childers (2018) interviewed 13 tinnitus sufferers to reveal some common themes of the tinnitus experience. Among them were dealing with loss - both of silence and control, making sense of the tinnitus and their emotional and behavioural reaction to it, and finally gaining acceptance.

Coping with Tinnitus: three key tips

#1: It is ok to grieve what tinnitus has taken away from you

The anger that a sufferer feels about their tinnitus can be understood as grief for what has been lost. Tinnitus is an intrusion into your private, once peaceful internal world. The auditory landscape of that inner world changes forever for chronic sufferers, and it is normal and natural to feel a sense of loss for that. Taking time to acknowledge and give space to those emotions is an integral part of managing tinnitus.

#2: Stop beating yourself up for having it

Part of the sense-making process around tinnitus may involve working out what caused your tinnitus, which may lead to self-blame. But self-blame is a key maladaptive coping strategy in tinnitus (Trevis et al, 2016). It can fuel a person's inner critic and keep them stuck in a vicious self-critical cycle that makes them feel worse.

#3: Fighting the tinnitus is not going to help

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Do not think of a white bear right now. A polar bear in the snowy wilderness. Just don't. Do not think about his fluffy white fur and dark brown nose.

What happened there? Did you manage to not think of a white bear? This classic thought suppression experiment shows that we tend to always think about something when we try not to think about it. It is the same with tinnitus. When you try and distract yourself, try to push it away, not think about it, and not hear it, it worsens in the long run.

So instead of struggling with it, an alternative is to accept it. You don't want that constant sound there (who would?), but it is there all the same. Research shows that the more you can accept the tinnitus, the less the subjective experience of tinnitus severity and loudness, and lower levels of anxiety and depression (Hesser at al, 2015).

As one participant in Pryce and Childers (2018, p. 805) study put it:

"Once I gave in and thought actually I can't control it, that's kind of when the battle, me and the tinnitus, decided to call a truce"

Acceptance in the context of tinnitus does not just involve accepting the tinnitus sound/s but also the difficult thoughts that can come along with the tinnitus. For example, "I can't live like this", "I can't cope", "It's too loud". Learning to defuse, step back from these types of thoughts so that the power is taken out of them, is a key component of managing tinnitus.

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Final thoughts

• Chronic tinnitus can be debilitating and can have a detrimental affect on a person's mental health.
• You may not be able to escape the noise of tinnitus, but you can take steps to reduce the impact tinnitus has on your life.
• Some suggestions here include: giving space for feelings of loss, managing self blame and self-criticism, and moving towards acceptance of the tinnitus.

This post was also posted on the Harley Clinical Psychology website.