2. Tinnitus Retraining Therapy: How does it work?
normally a valuable warning and alerting stimulus – for instance sound
can be heard round corners, and in the dark. Therefore sound is
naturally wired to generate alarm, producing the fight-or-flight
response. However, the alarm in itself tells us that the sound is
important, and this directs our attention to it and makes us hear the
sound even more strongly. So the alarm generated by the sound becomes
even greater. The result is that a vicious cycle can set in: tinnitus ->
alarm -> tinnitus. The tinnitus is heard more strongly -> yet more alarm ->
yet more tinnitus, until it can come to dominate someone’s life. This
is particularly the case with something like tinnitus, where the sound
is not only unwelcome, but the listener may feel helpless and unable to
Retraining Therapy aims to reverse this process, (1) firstly by
allowing the patient to achieve some control over the tinnitus, so
reducing the sense of helplessness, and (2) then by reducing its
significance, so it becomes like one of the background sounds that are
present but not normally noticed. Indeed, a common outcome of therapy
is that while the tinnitus is still present, it is no longer noticed,
unless the patient’s attention is drawn to it (by reading about
tinnitus, for instance).
Normally external sound at the ear will stimulate nerve cells in the brain (red). B: But if there
is some hearing loss, some brain cells will not get a stimulus (white). So over
time, they will learn to make their own activity (because nerve cells like to
be active: red). C: This means that even when there is no external sound,
these nerve cells will continue to be active, making sounds in the head
(tinnitus: red). D: If this generates alarm, it tells the brain that the
activity is important, and the activity will spread to other nerve
cells, so the tinnitus can become louder.
will have their own favourite protocols, but there are two elements.
(1) The first is reassuring psychological therapy, to reassure the
patient that the tinnitus can improve over time, can be controlled, and
does not signify the existence of serious underlying disease (except
for the hearing loss). The patient is shown techniques to reduce the
stress produced by tinnitus. (2) Patients are then given control over
the tinnitus, initially by the use of appropriately-chosen maskers to
hide the tinnitus, and then by the use of distracting sounds, so that
the patient learns that even though he or she can hear the tinnitus, it
has no significance for them.
What does Tinnitus Retraining Therapy involve?
Next page: What happens in Tinnitus Retraining Therapy?