One in seven people will suffer from tinnitus at some point in their lives and yet its causes are unknown and treatments are only partially effective. A new clinical trial highlights the remarkable promise offered to sufferers by Mindfulness-Based Cognitive Therapy.
If you have ever suffered from tinnitus, you will understand what a surprisingly distressing condition it can be. It can lead to anxiety, stress, depression, insomnia and impaired hearing and concentration. Its medical definition of ‘the sensation of hearing sounds in the absence of any external sound’ barely reflects the impact it has on day to day life.
I suffered from tinnitus for several years and it still returns from time to time. I managed to control the condition using Cognitive Behavioural Therapy (CBT) and mindfulness. I was taught CBT at hospital where it was called Tinnitus Retraining Therapy and I used my own mindfulness sessions to enhance its effect. And I found it surprisingly effective. The tinnitus in my right ear disappeared completely. Some ringing returns to my left ear from time to time, but it no longer bothers me.
Nor is my experience an isolated case. New research shows that mindfulness can have a big impact on tinnitus. Dr Laurence McKenna of University College London Hospitals NHS Foundation Trust and Dr Liz Marks of the Department of Psychology at the University of Bath, have found that Mindfulness-Based Cognitive Therapy (MBCT) can help sufferers far more effectively than the relaxation-based treatments currently taught by many tinnitus clinics.
Dr Marks’ team compared MBCT to relaxation therapy, the normal treatment for people with chronic tinnitus, to determine if MBCT was a better option.
“In total, 75 patients took part in the trial at UCLH’s Royal National Throat, Nose and Ear hospital receiving either MBCT or relaxation therapy. The study found that both treatments led to a reduction in tinnitus severity, psychological distress, anxiety and depression for patients,” said Dr Marks.
“The MBCT treatment led to significantly greater reductions in tinnitus severity, and this improvement lasted for longer. In addition, 182 patients who completed MBCT routinely in our clinic showed a similar level of improvement.”
MBCT teaches patients to pay purposeful, present-moment attention to experiences, rather than trying to suppress them. In the case of tinnitus, patients were encouraged to meditate on sounds, including that of the tinnitus, and to follow how it rose and fell, how its pitch and timbre changed, and also to place it in the context of the wider ‘soundscape’. This cultivated a more helpful way of responding to tinnitus. People learnt how to allow and accept tinnitus rather than trying to fight or suppress it. Even though this mindful approach did not aim to change the nature of the tinnitus, it led to it becoming less intrusive to the point where it was no longer a problem. In many cases, it disappeared completely.
Dr Marks added: “MBCT turns traditional tinnitus treatment on its head – so rather than trying to avoid or mask the noise, it teaches people to stop the battle with tinnitus.
“The mindfulness approach is radically different from what most tinnitus sufferers have tried before, and it may not be right for everyone. We are confident, however, that the growing research base has demonstrated how it can offer an exciting new treatment to people who may have found that traditional treatment has not been able to help them yet. We hope the results of our research will be one of the first steps to MBCT becoming more widely adopted.”
So how does MBCT, and mindfulness in general, have this effect?
To answer this question, its first necessary to understand the true nature of tinnitus. While its cause is unknown, it is clear that tinnitus is not a disease or an illness in the normal sense. Rather, according to the British Tinnitus Association, it results from some type of change that can be either mental or physical and may be unrelated to hearing. It is probably akin to neuropathic pain, except patients hear non-existent sounds rather than feel the sensations of pain.
Neuropathic pain occurs in the nervous system and often normal investigations fail to discover a clear cause. It might result from damage to the nerves, spinal cord, or brain. But sometimes pain is felt even when there is no damage, or when healing seems to have completed at the site of an illness or injury. Such neuropathic pain can also take the form of unusual sensations, such as burning or electric shocks, and can even ‘occur’ in amputated limbs. Or it can take the form of tinnitus.
It is believed that tinnitus arises when background electrical or ‘white noise’ in the sound processing systems of the ear and brain become unduly amplified. The auditory system is highly sensitive and the nervous system is naturally ‘noisy’. Normally, the auditory system screens out this background electrical noise. However, if the background electrical noise rises above this auditory threshold – or the threshold is lowered – then you will hear the hissing sound of white noise, or tinnitus. What happens next is crucial to the progress of the condition. In some people, the noise is perceived as alarming and the body’s fight or flight system is activated. This ensures that the brain begins to actively search for the sounds of tinnitus because they are seen as a threat that needs to be avoided. The brain and nervous system then responds by increasing its capacity to process the noisy tinnitus signals – rather as a computer devotes extra memory and circuits to an important task. So the brain begins to act like an amplifier that’s stuck on ‘high’.
How you then react to tinnitus determines whether it is amplified further or fades away of its own accord. If you learn to accept the condition by paying conscious attention to the sounds by, for example, mindfully following how it rises and falls, and its changes in pitch and timbre, then you begin to accept the background noise. You can begin relaxing into it. The brain then no longer sees the noise as alarming and begins to naturally screen it out once again. Mindfulness also reduces anxiety and stress, which probably reduces the level of ‘white noise’ in the nervous system. In addition, lowering anxiety and stress can take you off a hair-trigger, and, in effect, lowers the brain’s sound amplifiers still further.
The Sounds and Thoughts meditation seems to be particularly effective for tinnitus although the whole MBCT programme reinforces the benefits.
The researchers in London and Bath now hope to extend their research to see whether it can help with tinnitus related insomnia. Given that mindfulness is an effective treatment for insomnia in its own right, the chances for success are high.
You can try some shortened MBCT meditations here. These are taken from my bestselling book Mindfulness: Finding Peace in a Frantic World co-written with Professor Mark Williams, co-developer of MBCT.
You can also try some free meditations from my book Mindfulness for Health (published in US as You Are Not Your Pain) here.
Please seek medical guidance before you try incorporating mindfulness into your own tinnitus treatment.
Find out more about the condition from the British Tinnitus Association.