How to manage the mental health impact of tinnitus

Its impact isn’t limited to physical symptoms — the constant presence of unwanted sounds can lead to frustration, anxiety, sleep disturbances, brain fog, concentration issues, and even depression. Studies show 30-40% of people with tinnitus may also experience anxiety or depression, depending on the severity of their symptoms and their coping strategies.

The psychological impact of tinnitus

For many, the distress of tinnitus isn’t just about the presence of the sound itself, but their reaction to it. They often develop trigger thoughts like, 'What if it gets worse?' or 'What if I can never sleep again?' Some people linger on these thoughts and start worrying excessively, leading to hyper-awareness of their condition. Tinnitus sufferers also might get impatient and “angrily ruminate” about the impact of the ringing sound when they get annoyed with it.

Metacognitive Therapy (MCT) approaches the mental health aspect from a totally new perspective: It suggests that it’s not tinnitus itself that causes mental distress — it’s the thought patterns and behaviours people engage in in response to it. MCT helps people reframe their relationship with their condition by addressing the patterns that maintain their distress.

Challenging your coping strategies

People with tinnitus often use coping strategies that unintentionally reinforce their distress:

• Constant monitoring: They may become hyper-focused on their tinnitus, frequently checking whether it has worsened or improved, which heightens their awareness and distress.
• Avoidance behaviors: Some people avoid silence entirely, constantly using background noise to drown out tinnitus, while others do the opposite, seeking complete silence in an attempt to escape it.
• Worry: Many engage in excessive worry about their tinnitus and the possible consequences if it continues or gets worse. Some people also worry that they'll literally go crazy from the ringing sound, which exacerbates their anxiety.
• Rumination: It's common to engage in excessive analysis, trying to understand the cause and fluctuations of their tinnitus. They look for patterns in their daily activities and explanations of why their symptoms change. 'If only' thinking is also common, and leads to feelings of sadness and regret.
• Metacognitive beliefs: Many people hold beliefs such as 'If I monitor my symptoms, I’ll find a solution' or 'I have to get rid of my tinnitus before I can enjoy life again.' These beliefs keep them stuck in cycles of anxiety and frustration.

Unfortunately, these strategies often backfire. The more you monitor and analyze tinnitus, the more intrusive it becomes, leading to increased distress and symptoms. And avoidance behaviours can ultimately lead to social withdrawal and isolation, which then leaves more time for rumination and worrying.

How Metacognitive Therapy can help

Unlike traditional therapy methods, Metacognitive Therapy targets the thought processes that sustain mental distress. Instead of trying to eliminate the sound or rationalize your symptoms, MCT helps people shift their beliefs around tinnitus-related thoughts and worries through the following approaches: 

1. Challenging negative metacognitive beliefs

Many people with tinnitus believe that their worry and rumination is uncontrollable, and that it can lead them to lose control or go crazy. MCT helps you discover that these thinking patterns aren't actually uncontrollable or harmful.

1. Reducing the significance of worry and rumination

A core component of treatment is showing people that excessive worrying and rumination doesn’t provide helpful solutions, and actually makes you feel worse. MCT helps you recognize when you’re engaging in the cycle of overthinking and how to let go of these thinking patterns.

1. Reducing threat monitoring

Many people believe that monitoring their symptoms will help them manage their condition, but it just ends up making them more focused on the sound. By decreasing hyper-awareness of tinnitus, and disengaging from constant internal checking, people can focus on their daily lives instead of becoming consumed by their condition. 

1. Breaking the cycle of avoidance 

Many people who struggle with tinnitus put their lives on hold, avoiding social situations, hobbies, and even work because of their condition. MCT encourages people to gradually reintroduce these activities, helping them discover that they can still lead fulfilling lives with tinnitus.

It’s completely understandable to experience distress as you navigate tinnitus. But the key to managing it is changing your response to it. While tinnitus itself may not disappear, MCT can really reduce the psychological impact of the condition so you can regain a sense of normalcy, mental peace, and overall well-being.

To learn more about Metacognitive Therapy and how it can help you, check out this article for a deep dive on the method.