My Unexpected Tinnitus Transformation Using Internet-Based Cognitive Behavioral Therapy

By Jordyn Costosa

When I was five years old, I remember lying in my bed at night and hearing ringing in my ears. I wondered what it was, and I ended up telling myself that it was my brain making a noise so I would never be alone in silence. As such, I viewed my tinnitus as a comforting friend.

One day when I was 10 years old, I overheard my father talking to my grandmother about the ringing in his ears. After hearing that conversation, I told my parents that I have always heard ringing in my ears, and they explained that I have “tinnitus.” I didn’t understand that tinnitus was not normal, so it didn’t bother me. Around age 12, however, that changed when I was taken to see an otolaryngologist and audiologist about my tinnitus. Those appointments made me realize that not everyone has the condition. I didn’t have hearing loss or any other underlying health condition that might have triggered it, so they couldn’t tell me the cause.

From that point onward, tinnitus was a source of annoyance and anger, not comfort; it became a burden. I would sit in a quiet room trying to study and find myself focused on the high-pitched frequency that would not leave me alone. When I tried to fall asleep, I would only hear my tinnitus. The hardest time for me was during standardized testing in middle school and high school, and during exam week in college, because the silent testing environment made it hard to concentrate. I loved hearing a pencil drop, a page turn, and even a student coughing because it gave me a split-second escape from my tinnitus.

I envied my brother and others who were able to hear silence. I longed for that experience, if even for a moment. To avoid my tinnitus, I drowned it out by playing music in the background, never sitting in a silent room unless I had to, and always running my fan on high when I went to bed. Tinnitus controlled my life, and I spent so much time worrying about how to avoid being in silence.

All that changed during the Covid-19 pandemic lockdown, when I took an online audiology class with Professor Ali Danesh, PhD, of Florida Atlantic University. The class helped me revisit and recalibrate my relationship with tinnitus.

When the course touched on the topic of tinnitus, I shared with Professor Danesh that I’ve had tinnitus for as long as I can remember. He suggested that I try iCBT for tinnitus (internet-based cognitive behavioral therapy), which is designed to teach people with bothersome tinnitus techniques from cognitive behavioral therapy to diminish tinnitus distress.

At first, I was skeptical about whether internet-based CBT would actually enable me to “ignore” my tinnitus. But being confined to home during quarantine, as opposed to spending my days on campus, had made my tinnitus much more noticeable, so I decided to try the program.

Learning how to apply positive psychology to my tinnitus changed how I felt when there was limited background noise for me to rely on to relieve me from the sound of my tinnitus. The program showed me that, although I am not able to stop the ringing, I can change the way I feel about it and recognize more objectively how it is affecting me, which is a stark change from the way I felt about my tinnitus between the ages of 13 and 21.

The program emphasized that tinnitus cannot control my life, and the first step in diminishing its importance starts with knowing that tinnitus cannot control you. This realization enabled me to manage my tinnitus by changing my mindset.

In the Behavioral Experiment module, for instance, I completed a worksheet on negative thoughts that I imagined would arise during certain activities, causing me to become annoyed, angered, or distracted. One negative thought was “I cannot enjoy reading a book in a quiet setting.”

Part of the exercise was a “method of experiment,” which asked me to do what I imagined would bother me. That process helped me understand how tinnitus actually impacted me during this time because I first had to predict the impact of tinnitus on a scale of 0 to 100 percent, with 0 being not at all and 100 being all the time, then assess the actual impact of tinnitus using the same scale after the activity.

Prior to the experiment, I thought that reading in a quiet environment would affect me 30 percent. I gave it 30 percent because I would not be reading in a silent environment. Reading in an environment that included background sounds from a fan, people having a conversation in another room, and birds chirping outside my window, I realized my tinnitus actually affected me only about 5 percent of the time. My tinnitus annoyed me when I lost focus on my reading. But if I stayed focused on what I was doing, my tinnitus never entered my thoughts.

One of the most beneficial modules for me was “Positive Psychology in Tinnitus Management.” I learned about human strengths and virtues, such as temperance, wisdom and knowledge, and humanity, to name a few. I had to rate myself on six strengths and virtues, explaining why I rated myself the way I did. I also wrote down five distinct strengths and how I’d use them in the future. This process helped me see that nothing — especially my tinnitus — can weaken my strengths and who I am as a person. Tinnitus cannot change my work ethic or the love I have for my family. It cannot take away my ability to read or take away my understanding of a television show that I might be watching at night in my room. My tinnitus does not control me or any other aspect of my life, so why not change my mindset to accepting something I can’t prevent or stop?

Today, I am able to take away more positives than negatives when my tinnitus is louder than normal. For instance, prior to taking the course, whenever my tinnitus was louder than normal as I was trying to fall asleep, I would become very frustrated. This frustration then caused me to become more alert and resulted in me being tired the next day. With the skills I gained from the program, I handle the situation differently. Instead of becoming frustrated, I recognize that, although the ringing is present, I actually am tired, I am in a comfortable bed, and I am surrounded by cool air. None of these factors can be taken away from me or altered by my tinnitus.

I’ve realized that tinnitus does not control my life, cannot physically change my situation, or will not diminish any of my abilities. The program pushed me to recognize that if I continue to let my tinnitus take over different aspects of my life — my thoughts, emotions, and behavior — it will continue to affect me negatively. I use the techniques to focus deliberately on positives. I live a good life, I have amazing friends and family, I am grateful for all that I have, and tinnitus cannot affect any of that. This was the most critical concept I took away from the program.

The program also made me reflect on my early experience with tinnitus as a child, which caused me to have a transformative realization about the effectiveness of the CBT techniques. I rediscovered the usefulness of my original view of tinnitus. Today, I’m able to perceive tinnitus as an old friend providing comfort, not a burden. Drawing on my childhood thoughts, I am able to say that I am not “alone,” because my “friend” (tinnitus) is with me. In a way, this outlook makes me feel special and gives me a whole new mindset. Had I not taken the program, I would never have revisited my childhood relationship with tinnitus and found a way to release the control I had given to tinnitus over my thoughts, emotions, and behavior.

I am also more positive than I was prior to taking the program, which I didn’t anticipate. When I first looked at the modules and saw that it was teaching acceptance of tinnitus and positive thinking, I felt frustrated by what I perceived to be a mind gimmick. But once I took a step back and looked at the big picture, I realized the program wasn’t based on becoming resigned to tinnitus — just living with it or being more positive about it — but rather was about freeing the mind of the power assigned to tinnitus. Each step brought me closer to understanding that I have power over my tinnitus and that it cannot take away anything from me or from any aspect of my life. Framing tinnitus this way makes me think more highly of myself and gives me a more positive outlook on my tinnitus as well as my life.

The techniques I practice have changed how I live with tinnitus and helped me learn how to deliberately put tinnitus on the backburner. Better yet, the iCBT course taught me to have a more positive outlook on my life and has enabled me to handle various life situations — beyond tinnitus — differently from how I would have prior to the program. With lockdown in the rearview mirror, I am stronger today thanks to this course.

This past April, Jordyn Costosa graduated with a Bachelor of Arts in languages, linguistics, and comparative literature, with a concentration in linguistics. An aspiring speech-language pathologist, she will be attending a graduate program for communication sciences and disorders in the fall. Although she is looking forward to gaining experience in working with a variety of clients in all age groups, her goal is to work with children within the school system.