Tinnitus, powerlessness and PTSD: Framing tinnitus as an acute stress disorder
If you ask a hundred tinnitus sufferers to explain how the ringing in their ears affects their quality of life, you will get a hundred different answers, but you could easily conclude that the root of the problem–emotionally speaking–is anxiety.
The sound of loud tinnitus can cause a very intense fight-or-flight stress response that never fully goes away, because the sound never stops. And being stuck in a vicious cycle of fight-or-flight certainly feels like anxiety.
But when you look deeper, you start to see that the core emotion at the center of every problematic case of tinnitus is not anxiety–it’s powerlessness.
It’s feeling utterly powerless to find any kind of relief in the face of a confusing health problem that is actively destroying your quality of life.
All of the anxiety, fear, sadness, and every other negative emotion that tinnitus sufferers experience–it all flows outward from this central feeling of powerlessness, which is only magnified during times of great stress, like a pandemic.
But you are not actually powerless like you think you are. You just need to understand where your power lies, and how to exert that power to achieve results. Some things are within your control, and some are not.
Differentiating between the two starts with a better understanding of the problem.
How tinnitus can make you feel so powerless
Imagine you’re watching a movie, feeling relaxed and fully distracted from your tinnitus, when suddenly there is an explosion on screen and the movie plays the high-pitched tinnitus sound that the hero is supposedly experiencing.
Hearing this sound will most likely cause you to immediately notice your own tinnitus in a negative way, possibly even louder than before.
Most tinnitus sufferers have had this experience, or something similar.
In that moment of anxiety, most people try to push the sound away. You will probably be thinking, “Please go away! Just let me enjoy my movie. I need 5 more minutes of peace!”
But now think about what is happening from the perspective of your nervous system.
Your nervous system is saying, “Hey can you hear that sound? Something terrible is happening! You need to get up right now and go deal with it!”
In response, you’ll think, “I don’t want to deal with this even for a second! Please just go away! Leave me alone and let me enjoy my movie!”
And so your nervous system responds, “What do you mean go away? Something terrible is happening! You can’t hear that sound? Okay–volume up, anxiety up, adrenaline up. All systems go! We have to deal with this right now!”
By trying to push it away, you are fighting against the way your nervous system evolved to protect you from danger, the way you would want it to protect you if the danger was real.
If the sound wasn’t your tinnitus but the fire alarm going off in the middle of the night because your home was on fire, you would want it to wake you up with so much adrenaline that you could pick up your family in one arm and your pets in the other while sprinting out of the house to safety.
But in some ways, this level of activation is happening on the couch, while trying to watch TV. We try to push away the sound of our tinnitus but fail, and only succeed in feeling more powerless (and more anxious and afraid).
Where powerlessness leads
On an individual level, tinnitus experiences can vary wildly case by case. Two separate tinnitus patients may give you two completely differing accounts of suffering.
One person experienced an acoustic trauma, the other a medication side effect. One hates noise, the other hates silence. One person hears a high-pitched tone, the other a loud low-pitched roaring sound, like a jet engine. One person isn’t bothered by the sound at all, the other is completely miserable.
Every patient has a different story to tell.
But despite all the differences, patterns emerge.
Most sufferers have had a medical professional incorrectly tell them there is nothing they can do about their tinnitus, that they just have to learn to live with it. (And what can make you feel more powerless than a medical professional wrongly telling you that your situation is hopeless?)
Many patients are deeply afraid that they won’t be able to find relief, which can mutate into feelings of sadness and a state of depression.
Nearly all sufferers experience high levels of stress and anxiety.
It starts with powerlessness, but the downstream psychological and emotional impacts of tinnitus can quickly become significant and overwhelming. Patients can begin to feel like they are trapped in a 24/7 state of suffering and anguish.
It can become hard to eat, hard to sleep, hard to focus–hard to feel normal at all, let alone happy.
I experienced this myself with my own tinnitus, and I’ve witnessed it firsthand in the hundreds of other patients I’ve worked with over the years.
Even patients with no prior history of mental health problems can begin to exhibit signs of deep depression and intense anxiety.
There is always hope, even in the most severe cases. Despite what your doctor may have told you, there is absolutely something you can do about your tinnitus. With habituation alone, you can get your quality of life back to what it was before the tinnitus started.
But when tinnitus becomes severe, it can be utterly terrifying.
In fact, the health problem that tinnitus most closely resembles is not another ear or hearing problem, but post-traumatic stress disorder (PTSD).
Framing tinnitus as a stress disorder
In my opinion, a more accurate description of tinnitus might be acute auditory stress disorder (AASD).
Right now, tinnitus is primarily thought of as a hearing health problem. If there were a reliable medication, surgery, or treatment that could cure tinnitus outright, this framing would be fine. But in absence of a cure, treating tinnitus is a lot more like trying to treat PTSD than any other hearing problem.
In both cases, a person is triggered repeatedly into a state of intense stress/anxiety and emotional despair. With both tinnitus and PTSD, the nervous system ends up in a continuously over-activated state of fight or flight that never fully resolves, creating a vicious cycle of suffering.
Even the way the suffering manifests looks similar: A trauma survivor who is actively suffering with a PTSD episode will experience many of the same psychological and emotional impacts as a person experiencing an intense tinnitus spike or episode.
It might seem like an arbitrary comparison at first glance, but it’s very important to understand the similarities. Because tinnitus, like PTSD, often requires a multidisciplinary treatment approach. The best results are often achieved through the combination of a variety of different therapeutic modalities like counseling, coaching, medication, treatment devices such as hearing aids/maskers when necessary, relaxation techniques, coping tools, and mind-body techniques, just to name a few.
There may not be a one-size-fits-all solution in either case, but with the right toolkit, acute stress disorders of all varieties can be resolved, and quality of life can be restored. Tinnitus is no exception.
PTSD: A personal example
When my wife Megan was 6 months pregnant with our son Zack, she was diagnosed with somewhat aggressive breast cancer.
The good news is that Megan is now nearly four years cancer-free! But at the time, it was a stressful nightmare.
She had a lumpectomy surgery while pregnant, and then shortly after endured a painful 3-day-long induced early labor. After my son was born (healthy and happy), Megan underwent IVF to preserve her fertility, followed immediately by chemo, radiation, and hormonal therapy. And all the while, we had a newborn baby at home–our first child.
When you’re in the middle of a situation like this, you just find a way to survive. We both did. But when her cancer went into remission and the dust settled, she really struggled with PTSD.
For months, Megan worked hard to resolve the PTSD and underwent many therapies including medication, intensive counseling, breathwork, and EMDR (eye movement desensitization and reprocessing).
And it all was working. It was slow going at times, but she was making great progress and having better and better days, and then better and better weeks.
But then, inevitably, something would trigger her PTSD in the middle of it all and she would have another episode.
Where tinnitus and PTSD meet
When Megan experienced a PTSD episode, she wouldn’t dissociate, but she would feel the emotions all over again as difficult memories flooded into her mind.
And in this moment of despair, not only would she not remember that she had been having a great week up until that point, she often would not remember that there had been a single good day since the cancer occurred.
It would completely warp her sense of time and space. It was like she was stuck on a ship lost at sea, and not only was there no land in sight, but there never actually was land before, and there never would be again.
This is exactly what it can feel like to have an intense tinnitus spike, and something I hear constantly from my tinnitus coaching clients.
You can be having a great week, and a sudden change in tinnitus intensity can trigger the fear and powerlessness all over again. It can make you feel like you are right back to square one.
Difficult spikes and moments of tinnitus intensity always pass eventually, and once you calm down again, you will usually end up right back where you were before the spike started. But just like PTSD, it can be very hard to remember this when you’re in the middle of it all, actively suffering.
To successfully cope with difficult tinnitus spikes, you can’t just try to ignore and push away the sound.
Instead, if you approach your tinnitus like an acute stress disorder, the nature of your suffering will begin to make sense, and you can start to figure out the tools and strategies necessary to better cope.
The antidote to powerlessness is having the right knowledge, tools, and coping skills, and the confidence in your ability to use them effectively.
I still feel confident that we will cure tinnitus one day, and long before that day arrives, we will have more effective medical treatments.
But if you are suffering from tinnitus right now, you don’t need to wait for the next big breakthrough to find relief. Relief is possible now! Habituation, meditation, sound therapy, cognitive-behavioral therapy and other treatments are all options.
With current tools and therapies, you can address the PTSD-like underlying emotional and psychological obstacles preventing you from finding the relief you deserve. You can habituate to the sound and get your quality of life back to what it was before your tinnitus began.
Note: This article originally appeared on Rewiring Tinnitus and is reprinted with permission.