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Tinnitus and stress

Last updated on 10 April 2014

This information has been written to help you understand what stress is, how stress may affect tinnitus (and vice versa) and how stress can be managed.

Tinnitus is one of the most common conditions that people experience – approximately one in ten UK adults will have persistent tinnitus. Interestingly, however, most people would say that it doesn’t cause them problems. Furthermore, when people do ‘suffer’ with tinnitus, the type and extent of the difficulties they experience varies from person to person. One thing that may help explain these differences is the level of stress you are under. If you have a high level of stress there is a greater chance that you will be troubled by your tinnitus.

What is stress?

Stress is experienced by nearly everyone at various times in their lives. Stress occurs when the demands on you are not matched by your resources, or in other words your biological, psychological or social capabilities.

Stress can happen when the demands are too high, such as when you have too much to do. It can also occur when the demands are too low, when for example you are have too little to keep you busy.

Contrary to popular belief, stress is not always bad for your health. A certain amount of stress or arousal can be positive and help you to focus on the task in hand. The release of stress-hormones can help our bodies to do certain things, such as tackling a dangerous situation or running away to a safe place. Therefore in the short term, stress may be necessary for you to function well. In the longer-term, however, prolonged adverse stress can be very uncomfortable for your body and your mind.

How to recognise the signs of stress

The symptoms of stress vary widely in different people, but here are some common signs of stress to look out for in your body, thinking and behaviour:

Signs of stress in your body
  • Feeling tense
  • Quickened heart beat
  • Breathlessness or a change in your breathing, e.g. lots of yawning or sighing
  • Churning stomach, ‘butterflies’ or nausea
  • Sweating
  • Needing the toilet (empty bowels/bladder)
  • Poor concentration
  • Disrupted sleep
Signs of stress in your thoughts

If you believe you are facing a threatening situation, that something will go wrong or that something bad has already happened you will probably have thoughts that the situation will be very difficult, maybe even too difficult to deal with. For example:

  • “I can’t cope with this.”
  • “I’m never going to be OK again.”

It is also likely that your thoughts will become very focused on the thing that is stressing you. It may therefore be difficult to concentrate on other things. One result of this is that the problem will seem to grow in importance. This process is known as selective attention.

Signs of stress in your behaviour
  • Doing less of the things you enjoy, such as seeing friends, hobbies, reading or exercising less
  • Doing more things to try and manage the stress such as drinking alcohol, smoking, staying in bed, or using lots of distraction (e.g. long periods on the internet or watching TV)

Over time, these things may maintain the feelings of stress. They can also become problems of their own. Feelings of stress can also lead to other difficult feelings such as lowness of mood.

Causes of stress

Many factors can contribute to stress, including current situations, thoughts and behaviours. A cognitive behaviour therapy (CBT) framework is a way of understanding how the factors that contribute to stress are linked. This can help you to understand why you experience stress, why the stress keeps going, and how to think about ways that might help to reduce it.

The CBT model suggests that how you feel, whether it is sad, worried, stressed or happy, is strongly influenced by what you think and what you do. It is not just what happens to you that makes you feel stressed, but the way you think about these events.

For example, imagine it is late at night and you are asleep when you are suddenly woken up by a noise. You might think, “Oh no! Someone has got into the house!” and feel very frightened. Alternatively, you might think, “That’s the cat coming home,” and feel relieved. You might think any number of things. The CBT model proposes that the way you feel is largely determined by your thoughts about a situation rather than just the situation itself.

Unsurprisingly, stress impacts on your behaviour. For example, as a way of trying to manage your stress you may procrastinate or even avoid potentially stressful situations. This may help in the short term but in the longer term may lead to more stress, so trapping you in a vicious cycle of stress.

The relationship between stress and tinnitus

 

The way people respond to tinnitus varies greatly. For some people, it is considered the biggest stress in their life whilst others will respond to it in a neutral, calm way. You might suppose that this difference is due to different people having different tinnitus. This would make sense, but the research evidence on tinnitus does not support this idea. Instead the evidence suggests that the reason one person is stressed and another not is because they have different ideas or beliefs about tinnitus.

People who are stressed by their tinnitus tend to think about it in ways that reflect despair, hopelessness, loss of enjoyment, a belief that they will never get peace and quiet and a belief that others don’t understand. They may resent the persistence of tinnitus, wish to escape it and worry about their health and sanity. When thought about in these terms, tinnitus can be associated with a great deal of stress, and we will consider the impact of such thoughts shortly.

Additionally, various emotional and physical factors have been linked to the onset of tinnitus, including stress. Although it is not always clear whether stress causes the onset of tinnitus, or perhaps is a contributing factor, it is common for tinnitus to start at times of high stress or after a period of stress. It is also common for existing tinnitus to become worse during periods of high stress. For some people, tinnitus acts as their ‘barometer’ of stress, often worsening when there are difficult things going on in life. Of course, the worsening of tinnitus when you are already feeling stressed can add another burden, and lead to a ‘vicious cycle’ as each stress influences the other.

Attention and habituation

One way of understanding the relationship between tinnitus and stress is by considering the role of attention. Every minute of every day we receive hundreds of pieces of information from the environment. It is not possible for us to pay attention to all this information at one time. Fortunately, we have a system that allows us to select what we attend to at any given moment. The rest of the information is filtered out. The information that is filtered out is usually repetitive or unimportant. So for example, if we consider the ticking of a clock, we will very often not react to it and may forget that it is there unless we consciously draw our attention to it. In other words, we will get used to it or habituate.

If, however, information is seen as threatening and it leads to stress arousal then you will have difficulty filtering it out, or habituating, to it. In fact, if information is seen as emotionally important and your body is on alert then the opposite of habituation may happen; you may become more sensitive to the perceived threat. All this is relevant to tinnitus. If you see your tinnitus as a threat to your wellbeing your attention will focus on it. In such circumstances you monitor it, as you would any perceived threat. The process involves not only focusing on tinnitus but also paying less attention to other things. Focusing attention on tinnitus in this way may lead to the tinnitus seeming to be much louder and much more intrusive.

These changes in attention can therefore explain why tinnitus may start or become worse during periods of stress. It also might explain why the majority of people with tinnitus are able to experience the noises without being distressed by them.

Managing the stress of tinnitus

Making changes in one or more of the areas in the cognitive-behavioural model can help you to reduce unpleasant feelings, such as the adverse effects of stress, whether they be associated with tinnitus or with other troubles in your life.

Thoughts

Your thoughts are extremely important in influencing how you feel. Therefore it can be useful to pay more attention to your thoughts and work out whether they are helpful or not. Work through these steps to try and uncover and tackle unhelpful thoughts about your tinnitus:

1. Become aware of particular situations/times when you are especially distressed by your tinnitus.

2. Ask yourself, “What went through my mind at that time?” and then write it down. Don’t ponder – just write down what comes to mind.

3. Use the following questions to evaluate these thoughts:

  • What tells you that the thought is true - what evidence supports the idea?
  • Is there anything that tells you it is not true - what evidence do you have against it?
  • What is the worst thing that could happen?
  • If a friend asked you for help about the same problem what would you say to them?
  • What would a friend say to you?

By doing the above, you may be able to develop more helpful things to say to yourself about your tinnitus – for example reminding yourself that it is not dangerous and it is possible to still enjoy life with tinnitus. Changing the messages you tell yourself about tinnitus can help to reduce the impact on your life.

Physical reactions

Relaxation can be used as a way of dealing with the physical reactions associated with stress. Relaxation can take different forms for different people, but you may like to set aside some time to relax every day. Try not to expect this to help your tinnitus directly or straight away; most people find relaxation helpful but it requires time and practice. For more information, see the BTA leaflet Relaxation.

Behaviour

Some people find changes in their behaviour can help them to better manage their tinnitus, for example by focusing their attention more on interesting activities and less on the tinnitus. There are also a number of ideas that may reduce your general stress levels, which may also positively affect your tinnitus:

  • Exercise – appropriate to your fitness level
  • Making time for yourself
  • Spending time doing enjoyable activities and socialising
  • Problem solving or changing things in your life that cause you stress, if this is possible
  • Talking to supportive people, either friends and family or a counsellor or psychologist.

Further reading and references

McKenna L, Baguley D, & McFerran D (2010). Living with Tinnitus and Hyperacusis. London: Sheldon Press.

Baguley D, Andersson G, McFerran D & McKenna L, (2013) Tinnitus: A Multidisciplinary Approach. Oxford: Wiley-Blackwell.

A list of the references consulted in preparing this leaflet is available on request.

The authors wish to acknowledge the work of Tania Salvo in the production of an earlier version of this leaflet and of Barry Tam for his work on an early draft of this version.

 

Rebecca Mills, Jenna Love and Laurence McKenna, Psychology Department, Royal National Throat Nose and Ear Hospital, London

© British Tinnitus Association

Issued April 2014.Version 1.2. To be reviewed April 2017

 

This information has been produced in compliance with the BTA’s Information Production Protocol and no conflicts of interests have been declared.

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