The psychiatrist Viktor Frankl survived the horrors of the Nazi concentration camps and returned with one of the most important psychological lessons of the 20th century, which he detailed n his masterpiece, Man's Search for Meaning. He saw that of the many men and women subjected to the conditions of the camps, some were able to endure while others who were physically similar and subjected to the same conditions perished. The distinguishing characteristic, according to Frankl, was that those who had a strong sense that their life was meaningful—that they had a life’s purpose—fared much better than those who had no such sense. Out of this insight he created a system known as Logotherapy, a therapeutic intervention which stressed the importance of focusing on the meaning and purpose of one’s life as the key to psychological health and well-being. In modern psychotherapy, Acceptance and Commitment Therapy (ACT) has followed in these footsteps, insisting that true happiness does not come from the pursuit of pleasure or material rewards but in creating meaning in our lives through the process of living in accord with our values.
ACT is one of the therapeutic interventions that has been studied for tinnitus and with impressive results. A 2012 study comparing ACT and CBT concluded that “both treatments . . . showed large percentages of participants meeting the criteria for clinical significance for decreasing tinnitus distress, and both displayed significantly greater rates than in the control condition at posttreatment.” A 2011 study comparing ACT and Tinnitus Retraining Therapy concluded “A comparison between the active treatments, including all assessment points, revealed significant differences in favour of ACT regarding tinnitus impact.”
Studies generally attribute the success of ACT in tinnitus to the acceptance component of the intervention, which essentially uses mindfulness training to increase the patient’s willingness to accept distressing emotions. Here I want to discuss not the acceptance but the commitment component of ACT, for I believe this aspect of the intervention has a contribution to make to the quality of life of those with tinnitus.
To see this, it is important to understand that the unpleasant experience (be it depression, anxiety, or tinnitus) doesn’t go away as a result of being accepted. However, it does become less bothersome because we stop struggling with it. We no longer add mental suffering to the inevitable emotional pain of existence.
By itself, though, acceptance merely makes life less miserable. In order to complete the picture, we need to add positive value to our lives. This is where the commitment part of the therapy comes into play. It is not merely that I stop focusing what distresses me (e.g., my tinnitus). In addition, I start focusing on what is valuable and meaningful: my family, my job, my friends, my community, my spirituality, my hobbies and interests, my life plans and dreams. For ACT, it is the commitment to living a life according to our values that supplies the positive content and meaning for our lives. From this perspective, tinnitus becomes not a unique and possibly permanent obstacle to living a fulfilling life but instead one of the inevitable string of difficulties we encounter along the way of living a life filled with value and meaning.