Eye movement desensitization and reprocessing therapy (EMDR)is a type of therapy developed to treat post-traumatic stress disorder (PTSD) and has been shown to be incredibly effective in this capacity. It is one of the few therapies recommended for the treatment of PTSD by the American Psychological Association. Interestingly, there have been two studies testing whether EMDR can be useful in reducing tinnitus distress (Rikkert et al, 2018; Phillips et al, 2019). Both showed significant reduction in tinnitus distress as a result of a therapy. Since EMDR is primarily a therapy for treating trauma, the success of EMDR naturally brings up the question of whether tinnitus is somehow related to trauma.
Two possible explanations have proposed for the connection between tinnitus and trauma (Moore et al, 2020). First, it is possible that the tinnitus originated in a traumatic experience, for example, if the tinnitus were the result of a life-threatening event like a loud explosion. In my experience, this is a rare situation outside of military and first responders. The other possibility is that the tinnitus retriggers an early trauma. For example, “One’s negative belief about the meaning of having tinnitus (e.g., I’m not in control) might have a thematic link with a past, potentially unrelated traumatic experience (e.g., being the victim of violence).”
Both of these situations, however, focus on what we might call traditional trauma. Traditional trauma involves “exposure to actual or threatened death, serious injury, or sexual violence.” Traditional traumas are usually (though not always) one-time events. Anyone involved in some way in 9/11—from victims to first responders—experienced a traditional trauma. PTSD, for example, can only be diagnosed in relation to traditional trauma. And in fact there has been research demonstrating a link between PTSD and tinnitus (Fagelson, 2007).
Traditional trauma, however, does not exhaust the scope of trauma. In addition, there is what is referred to as complex or developmental trauma. Although perhaps not as dramatic as traditional trauma, complex trauma is much more widespread and, unfortunately, equally impactful. As opposed to traditional trauma, which usually involves a single event, complex trauma involves multiple events over time, for example, a child’s repeated exposure to abuse or neglect. Research has demonstrated the long-lasting and destructive impact of complex trauma on adult life. The related condition is known as C-PTSD (Complex Post Traumatic Stress Disorder). Anyone interested in this topic should pick up the best-selling book The Body Keeps the Score by Bessel van der Kolk.
Complex trauma opens up another possible pathway between tinnitus and trauma--one similar to that proposed for the connection between tinnitus and traditional trauma. Let’s say, for example, that my parents belittled me constantly and that as a result I never felt myself competent in handling challenges. Instead, I was made to feel powerless in the face of adverse circumstances and carried this insecurity into my adult life. Hence, when I am faced with the challenge of responding to tinnitus, my sense of helplessness as a child reemerges and blocks my ability to adequately deal with it. As the authors of the EMDR studies propose, this would mean that to treat the tinnitus we would need to treat the trauma.
The implication of trauma in tinnitus distress is a possible explanation for why many people with tinnitus are not helped by traditional cognitive therapy. Certainly, the few studies done on this topic in no way demonstrate such a connection. But the fact that many with tinnitus are not helped by CBT should cause us to look for other explanations outlets and the corresponding therapeutic interventions they would entail.
References
Phillips JS, Erskine S, Moore T, Nunney I, Wright C. Eye movement desensitization and reprocessing as a treatment for tinnitus. Laryngoscope. 2019 Oct;129(10):2384-2390. doi: 10.1002/lary.27841. Epub 2019 Jan 28. PMID: 30693546.
Rikkert M, van Rood Y, de Roos C, Ratter J, van den Hout M. A trauma-focused approach for patients with tinnitus: the effectiveness of eye movement desensitization and reprocessing - a multicentre pilot trial. Eur J Psychotraumatol. 2018 Sep 11;9(1):1512248
Moore, Tal & Phillips, John & Erskine, Sally & Nunney, Ian. (2020). What Has EMDR Taught Us About the Psychological Characteristics of Tinnitus Patients?. Journal of EMDR Practice and Research. 14. 229-240. 10.1891/EMDR-D-19-00055.