In a previous blogpost, I discussed what the research demonstrating that EMDR is an effective treatment for reducing tinnitus distress suggests about the connection between tinnitus and trauma. In short, since EMDR is primarily a treatment for trauma, the ability of EMDR to reduce tinnitus distress as shown in two studies suggests a possible connection between tinnitus and trauma. But what if instead of being connected—whether directly or indirectly to a traumatic event—tinnitus itself is trauma? As a trauma therapist with tinnitus, this is something I have long suspected. I have treated enough people with trauma to recognize PTSD symptoms in my tinnitus clients and students. In my opinion, tinnitus is as much an assault on the body as any physical assault.
And it seems I am not the only one with this insight. There is growing recognition of a condition called “Chronic Illness Induced PTSD.” More technically, this is known as the “Enduring Somatic Threat” model of PTSD. The idea is that having a chronic illness can bring on the same symptoms as PTSD. As an article in SELF magazine put it:
Chronic illness is an under-recognized and misunderstood source of trauma. “Oftentimes in our society and our culture, we think about trauma as something that’s associated with combat or a very violent, terrifying event,” says Dr. Ashwini Nadkarni, a Harvard Medical School instructor and psychiatrist at Brigham and Women’s Hospital who specializes in working with people living with a chronic illness “What’s not well understood is that the burden of having a chronic medical condition very much meets those criteria for a trauma experience.”
This becomes especially clear when we examine the classic symptoms of PTSD in relation to tinnitus.
Intrusion symptoms, which include re-experiencing the traumatic event. Those of us with tinnitus re-experience the trauma on a daily/hourly basis. It is there when we wake up in the morning and, at least for me, especially when I go to bed at night.
Hyperarousal symptoms for chronically ill people often manifest as an intense awareness of bodily sensations. Research demonstrates those with tinnitus are in a state of sympathetic activation. Difficulty sleeping and irritability are also hallmarks of PTSD hyperarousal and common in tinnitus.
Avoidance occurs as a way of managing the intense anxiety that accompanies re-experiencing and hyperarousal. In the case of tinnitus, we go out of our way so as not to experience situations that might cause our tinnitus to spike, to the degree that many of us avoid much of life.
Negative alterations in mood. These include negative beliefs about oneself, distorted cognitions about the cause of the event, persistent negative emotional states, diminished interest or participation in activities, inability to experience positive emotions--all of which sounds like an inventory check list of an new tinnitus client.
Now, importantly, if tinnitus can cause PTSD, this does not mean everyone with tinnitus will develop PTSD. Generally speaking, about 10% of those who experience a trauma develop PTSD, which is about the same percentage of those with tinnitus who report being distressed by it. This might be a coincidence. But then again, it might not be.
The upshot is: If tinnitus is trauma, this might explain why, for those in whom it develops into PTSD, a few sessions of CBT might not be sufficient to deal with it. Fortunately, the therapy filed has come a long way in treating trauma in the past couple of decades, and there are numerous innovative therapies that can be useful in working with trauma.