This chapter describes the ways in which people react to tinnitus and how these reactions come about. Reactions to tinnitus are understood within a cognitive behavior therapy framework. How a person thinks about tinnitus is seen as the most important thing. How we think about tinnitus can be influenced by things such as our stress level which can lead to overly negative or “middle of the night” thinking. This thinking can lead to changes in our behavior that may reduce anxiety in the short term but keep the problem going in the long term. We discuss ways of identifying and changing these thoughts and behaviors. When a person is successful in changing from “middle of the night” thinking to a more balanced perspective, then tinnitus becomes less intrusive.

Our approach to understanding tinnitus and people’s reactions to it is based on cognitive behavior therapy (CBT). This is a psychological approach that takes account of the links between the physical aspects of tinnitus and the emotional reactions to it. There is strong research evidence that this approach helps people with tinnitus and with many other problems.

What Type of Reactions do People have to Tinnitus?

The first really important thing to know about tinnitus is just how many people have it. Ten per cent of the adult population has tinnitus. This is a huge number of people. The next thing to know is that there’s a big variation in how people react to tinnitus. It may surprise you to learn that most people with tinnitus get along with it without any great distress. Other people suffering from tinnitus may experience feelings of anxiety or depression. They can become withdrawn or alternatively very restless. They frequently complain of poor sleep, difficulty in everyday functioning, or a reduced quality of life. Some people feel the need for antidepressants, sleeping pills or other tranquilizers.

For example, one of our patients, Bill (a well-educated, high-earning financier) became highly anxious when he developed tinnitus. He took sick leave from work and withdrew from his family and friends and spent periods of time in bed or lying on his sofa. His physician prescribed tranquillizers and antidepressants. This may sound very familiar but remember that most people with tinnitus are emotionally fine. It’s also the case that you can have a lot of problems with your tinnitus for a limited period of time and then move on to a calmer period during which you are much less annoyed by it. Given the choice, obviously most people would rather not have tinnitus; but after an initial stress reaction to it they carry on leading normal healthy and fulfilling lives and don’t attend tinnitus clinics.

Many people who do come to our clinics suppose that suffering is an inevitable consequence of having tinnitus. How often have we, as clinicians, heard a patient say: “Of course I feel like this. I have tinnitus! How could I feel any other way?” People see an inevitable link between having tinnitus and feeling bad, but the link is not inevitable. It is possible to have tinnitus and still be okay. Remember, most people with tinnitus are okay! After an initial stress reaction they simply stop reacting to the same old boring tinnitus sound and become largely unaware of their tinnitus for most of the time. This process is called habituation and occurs naturally so long as you regard the tinnitus as meaningless. Many people are greatly relieved to hear this. Some of our patients, like Bill, however, protest by saying: “Sure, other people might be okay, but they can’t have bad tinnitus. Mine is really bad and anyone who has what I have in my ears/head is bound to suffer. Surely, no one could habituate to a noise like this.”

The link, however, is not so inevitable. People with all kinds of tinnitus can be fine and people with all kinds of tinnitus can suffer. Do not despair if you have tinnitus. The outlook is very good. You too can get to a point where tinnitus does not play a prominent role in your life. Many of our patients find this hard to believe in the early stage, but it’s true.