Cognitive Behavioral Therapy

We commonly believe that how we feel is determined by the severity of the problems we face. For instance, if you have a stomach ache, you feel bad. But if you have a ruptured appendix and peritonitis, you feel worse. This concept holds true in cases where the pain pathways are concerned. However, in conditions that do not involve physical pain (and even in some conditions that do), how we feel is primarily determined not by the severity of our problems, but rather by our thoughts about our problems, no matter how severe. Moreover, in the stressed, distressed, or depressed individual those thoughts are often irrational and based in emotion rather than based in logic. Cognitive behavioral therapists refer to such irrational emotion-based thoughts as cognitive distortions. Carrying the process a bit further, it follows that distorted thoughts lead to distorted feelings and ultimately to distorted physical manifestations of those distorted feelings.

Perhaps an example adapted from a story originally related by cognitive behavioral therapist Dr. Laurence McKenna at a 1998 tinnitus seminar in Nottingham, UK might make it a bit clearer:

Fred gets into a subway train that is overflowing with passengers. A man starts poking him in the back with an umbrella for no reason at all. Fred gets angry of course. His pulse quickens, his blood pressure rises, and his face turns red. But when he turns around to tell the man to stop poking him in the back, Fred sees that the man isn't carrying an umbrella. He's carrying a gun. What happens now? Fred's face turns pale, his palms grow moist, and his mouth becomes dry. He reaches into his pocket to hand over his wallet, but when he turns around again, Fred discovers that the would-be robber isn't carrying a gun after all. In fact it's a blind man with a cane who is struggling to find a safe location in the moving train. The color returns to Fred's face, his pulse slows, and his blood pressure normalizes... as he assists the man to a nearby seat. So what has happened here? Within two or three minutes, Fred has felt anger, then fear, and then compassion - along with the measurable and observable physical changes generated by these three powerful emotions - all because of his thoughts about a few pokes in his back.

As we can see from this story, how our passenger feels as a result of the poke in the back is greatly influenced by how he thinks about it. Now severe tinnitus is certainly a far different and much more complex problem than a mere poke in the back. The rule, however, remains the same: Regardless of how loud or high-pitched your tinnitus might be, how your tinnitus makes you feel is to a great extent determined by your thoughts about it. Thus for any given level of tinnitus severity, whatever steps you can take to minimize or eliminate irrational emotion-based thinking, the better you will feel and consequently the better off you will be.

Often underappreciated within the medical community, cognitive behavioral therapy is one of the most powerful weapons in the tinnitus clinician's arsenal. Will it cure your tinnitus? No. But it will help even those with incredibly severe tinnitus return to a meaningful, productive, and truly enjoyable life, which as I see it is a very significant accomplishment indeed.