Acceptance and Commitment Therapy or ACT is one of the few therapeutic intervention besides CBT and mindfulness that has been demonstrated to reduce tinnitus destress. A 2011 study found that ACT was 2 ½ times more likely to produce meaningful tinnitus distress relief than Tinnitus Retraining Therapy (54.5% vs 20%) (9). Studies generally attribute the success of ACT in reducing tinnitus distress to the acceptance component of the intervention, which essentially uses mindfulness training to increase the patient’s willingness to accept distressing emotions (including the distress caused by the sound of tinnitus). According to ACT, trying to eradicate psychological distress is a futile task. Like Christ said of the poor, psychological distress will always be with us; it is part of the fabric of life. By resisting these negative emotions, we merely make them stronger. What we resist persists.
Instead, of fighting against the inevitable, ACT urges us to accept that negative psychological states are part of life. Oddly, once we adopt this attitude, the states that previously troubled us either become less burdensome or simply drop off. ACT loves metaphors, and one metaphor which you can find illustrated on YouTube is that of the unwanted guest. Imagine that you are throwing a party for all of your friends. You plan quite a big affair and invite everyone you know. But just as things are starting to get rolling someone you did not expect, your next-door neighbor Brian, shows up and insists on coming in. Brian is quite rude and unbathed to boot, and starts making a lot of noise, bothering the guests, and generally spoiling the mood of the event. So you throw him out. But Brian being Brian, he finds his way back in, and you throw him out again. After three or four ejections you realize that keeping Brian out will consume all of your energy and prevent you from participating in the party. So you give up and just decide to let Brian in. Two things happen as a result. First, you find that Brian actually calms down a bit when you stop bothering him. More importantly, you realize that despite Brian being there you can enjoy the party and being with your friends. It is easy to see why this strategy would be successful in the case of tinnitus, for habituation embodies just this state of acceptance of inevitable discomfort—not of an incredibly irritating neighbor but of an incredibly irritating noise.
What is sometimes overlooked when it comes to ACT is that this acceptance is not undertaken for its own sake but is part of a two-track strategy, the other part involving the commitment part of the intervention. Specifically, according to ACT it is the values we commit ourselves to in life that ultimately drive the acceptance component. That is, it is because we are engaged in important projects like having a career, raising a family, maintaining a relationship, achieving financial stability, increasing physical fitness, mastering a skill, and contributing to our community that we can shrug off the inevitable slings and arrows of life, be they psychological distress, physical illness, or the grating noise of tinnitus. As Nietzsche said, one can put up with any how so long as there is a why. Because of my tinnitus, I might avoid going to a crowded hospital. But if my child’s health were at stake, it is without question I would find the ability to do so. Applying this same state of mind not to a hypothetical incident but to the whole of our life, we realize that our tinnitus cannot hinder us from achieving what is truly of value in life.
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As with CBT, the best thing is to work with a therapist versed in this intervention. A good self-help guide to ACT is Get Out of Your Mind and Into Your Life by Stephen Hayes. When it comes to finding a ACT therapist, you are in the same situation with CBT therapists, except that there are far fewer therapists trained in this modality. Still your therapist should be able to point to some training or certification in this area.