Tinnitus and stress
How stress affects tinnitus and how to manage it
Tinnitus is a very common condition. Approximately one in seven UK adults has persistent tinnitus.
Most people with tinnitus would say that it doesn’t cause them problems. 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 stress.
Generally speaking, if you have a high level of stress, you are more likely to be troubled by your tinnitus.
Being aware of your stress levels and finding ways to reduce them, can help you to manage your tinnitus.
What is stress?
Stress is experienced by nearly everyone at various times in our lives. Stress occurs when the demands on you are not matched by your resources (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. 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. Our stress-hormone levels also rise in the morning, which helps us wake up and get out of bed! 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 from person to person. Here are some common signs of stress to look out for.
- Feeling tense
- Quickened heart beat
- Breathlessness or a change in your breathing, for example lots of yawning or sighing
- Churning stomach, ‘butterflies’ or nausea
- Needing the toilet (to empty your bowels or bladder or both)
- Poor concentration
- Disrupted sleep
When you are in a situation that your body feels is stressful, your thoughts will often focus on the negative. Your thoughts may suggest that the situation you’re in is going to be too difficult to deal with:
- “I can’t cope with this.”
- “I’m never going to be OK again.”
When stressed, it is easy to become very focused on the thing that is stressing you, making it difficult to concentrate on other things. This can mean that the problem will seem to grow in importance. This is known as selective attention.
The following behaviours can help to 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.
- 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 (for example long periods on the internet or watching TV).
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 by their tinnitus and another is not is because they have different ideas or beliefs about tinnitus.
People who are stressed by their tinnitus tend to show signs of despair, hopelessness or loss of enjoyment. They worry that they will never get peace and quiet and believe 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.
Emotional and physical factors including stress have been linked to the onset of tinnitus. Although it is not always clear whether stress causes the onset of tinnitus, or if it 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 you receive hundreds of pieces of information from the environment. It is not possible for you to pay attention to all this information at one time.
Fortunately, you have a system that allows you to select what you attend to at any given moment and filter out the rest (usually what’s repetitive or unimportant). So, for example, you may be in a room with a ticking clock. It is a sound you can ignore and you may forget that it is there unless you consciously draw your attention to it. You have got used to it – this is called habituation.
If, however, a piece of 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. This leads to you monitoring it closely, 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.
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 are associated with your tinnitus or with something else happening in your life.
Here are some tips to help you feel more in control of your thoughts, physical reactions and behaviour.
Your thoughts are extremely important in influencing how you feel. Therefore, it can be useful to pay more attention to them 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 was going through something similar and asked you for help, what would you say to them?
- What would a friend say to you?
By doing this, you may be able to develop more helpful things to say to yourself about your tinnitus. For example, you could remind yourself that tinnitus 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.
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 our pages on relaxation and relaxation without sound.
Some people find that making changes in their activities and behaviour can help them to better manage their tinnitus. This helps to focus their attention on more interesting activities and less on the tinnitus.
Here are some activities which may reduce your general stress levels, which in turn 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
- Talking to supportive people, either friends and family or a counsellor or psychologist.
Recommended further reading
McKenna L, Baguley D, & McFerran D (2021). Living with Tinnitus and Hyperacusis. London: Sheldon Press. Baguley D, Andersson G, McFerran D & McKenna L, (2013) Tinnitus: A Multidisciplinary Approach. Oxford: Wiley-Blackwell.
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