Cognitive Therapy and Tinnitus Treatment

Sally was referred to me by a neurologist who specializes in treating ear disorders.  The neurologist was familiar with the efficacy of cognitive-behavioral therapy and its application in treating pain-related syndromes.  Therefore, I was chosen to complete my part of a multidisciplinary approach to managing this particular patient's problem.

Tinnitus is a ringing, swishing or other type of noise that seems to originate in the ear or head.  Nearly 36 million people suffer from this disorder.  Many factors, such as certain medications, ear wax, fluid, infection or disease of the middle ear bones or eardrum can cause tinnitus. As with any pain syndrome or disturbance, emotional factors can impact the disorder.

Sally complained of a loud, swishing sound emanating from both ears.  The disturbance was significant enough that it began affecting her ability to function in a meaningful manner.  At home, while preparing dinner, she found herself shifting her head in a cramped position toward her right shoulder in an attempt to minimize the annoying vestibular volume.

Her bodily compensation reminded me of a clutched position that battle-scarred soldiers assume in combat that represents a way of warding off impending doom.  In reality, such posture actually characterizes the heightened hypervigilance experienced by those who have been exposed to physical and emotional trauma.

It is been my experience that a pain syndrome often serves as a mysterious metaphor for the way we relate to the world.  M. Scott Peck, author of the Road Less Traveled, used to talk about the nemesis of his neck pain.  Although he sought surgery to rectify his condition, he viewed his problem as a more complex pattern.  The origin of his neck stiffness transcended bones and tissue.  Peck often said “he was afraid to stick his neck out." His malady was a metaphor for holding things in and avoiding conflict at all costs.  Learning to assert himself paid dividends, and further minimized the significance of this problem.

As Sally and I talked, I began to see a thread that linked her nonsensical noise into a self-defeating cycle.  "The volume was chronically turned up in Sally's life and it made her head spin."  She often affirmed my diagnostic impressions.

Sally had always done what others required of her.  Her earliest recollections of this behavior occurred when walking home from school on a snowy day with several friends.  As a mean-spirited lark, her friends ask her to stick her head in a snow drift.  She obliged your friends so as not to disappoint them.  She felt humiliated as her school-mates looked on and laughed at her.  From that moment forward, the power of pleasing others began to serve as a benchmark for how she would conduct her life.

Alfred Adler used to say that our earliest childhood recollections consisted of a constellation of beliefs, thoughts and feelings that had a profound impact on one’s life.  Sally's experience in a snow-bank would fuel her later behavior in adulthood.

Sally worked as a full-time violin teacher.  Her students loved her.  One day, she taught ten students in a row, driving to and from each student's house.  She then went home, did -the laundry and prepared her evening meal for her and her husband.  It was typical for her to push to accomplish tasks for others without ever setting boundaries for herself.  She never requested or required any thing from others – finally she gave in to exhaustion.

As Sally began to disclose more freely in therapy, her story of unyielding sacrifice for others at her own expense became more evident.  All the money she earned went to subsidize her only daughter who refused to work although she suffered from a treatable mental health disorder.  Sally enabled her daughter and now this adult/child was holding her mother hostage.  Sally disclosed that her daughter had a $400 a month cigarette habit.  Although she was conflicted about supporting her daughter's addiction, she paid her the money to cover the cost.  Sally's regret rather than resentment was expressed.

In order to decrease the background noise in Sally's life, we worked on the following issues:

• Balancing the need to please with a sense of personal protection
• Learning assertiveness skills
• Requesting and allowing others to care-take for her
• Letting go of the need for frenzied activity
• Listening to her body and honoring it by slowing down
• Learning to get un-trapped from the fear of abandonment
• Learning to never do for others what they can do for themselves
• Relaxing the sympathetic nervous system through exercise and meditation

In order to address the above issues and decrease the volume of her tinnitus, I work with Sally on her thoughts, distorted cognitions and underlying assumptions about life.  I taught her to rationally respond to self-defeating thoughts and behaviors.  Some of the types of thoughts we reframed were:

• "Where is it written that people can't get along without me?"
• "If I say no, and people don't like it, it's their problem."
• "It's okay to have abandonment feelings, just don't act on them."
• "I need to focus in the moment rather than stressing about things I can't control.  If certain things don't get completed, it's not the end of the world."
• "" I need to treat myself as if I were a dear friend.
• "If I give in to others, I'll only resent it later. 
• What's the hurry, anyway?"

As a result of the modifications of her thought-processes, Sally began to make emotional progress with her tinnitus and she learned that self-defeating thoughts were a metaphor for that which aggravated her ears.  These were factors that complicated her condition by creating unnecessary stress.