果冻影院

Last week I retired from the NHS after 40 years of frontline service as a clinical psychologist.聽Much of that was spent working with people with tinnitus.聽

A colleague asked if I had seen many changes in the way tinnitus is treated.聽It鈥檚 not an easy question and the answer is, of course, yes and no.聽40 years ago, the usual response to someone asking their GP or ENT doctor for help with tinnitus was some version of 鈥渋t鈥檚 called tinnitus, there is no cure, you have to learn to live with it鈥�.聽

Positive change in perceptions of tinnitus

That response has not completely disappeared聽unfortunately, but it is much less common than it used to be. The medical and other helping professions have become more literate about tinnitus and there is a clearer understanding that people can be helped.聽This change was also seen in the campaigning and advocacy that takes place on behalf of the tinnitus community.聽

This change, in itself, is very positive. The old message made many people more anxious and worsened their experience of tinnitus.聽

40 years ago, if someone did get to see a specialist they were likely to be offered hearing aids (if they had hearing loss) or devices to mask the tinnitus sound.聽This was usually accompanied by some information about the working of the ear and some general advice about avoiding stress.聽This approach helped some people but not enough, and the links between theory and practice were poor.聽

The development of psychological approaches

Things started to change when, in the early 1980s, clinical psychologists were invited to put their minds to helping people with tinnitus.聽

They suggested that tinnitus distress could best be understood and alleviated using the concept of cognitive behaviour therapy (CBT). In the decades that followed, studies and clinical trials confirmed the benefits on this approach and the theory-practice links were strengthened.聽

More recently, we have developed a clearer realisation of the links between tinnitus and insomnia, one of the biggest impacts of tinnitus.聽Importantly, evidence has emerged that treating the insomnia, rather than the tinnitus, can lead to an improvement in both.聽

CBT does not 鈥渟witch tinnitus off鈥� but it can reduce the associated suffering and allow people to lead normal lives. The theory and practice of CBT itself has developed over the decades and with that we have seen the emergence of 鈥渁cceptance鈥�-based therapies such as mindfulness based cognitive therapy (MBCT) and acceptance and commitment therapy (ACT).聽

Both of these approaches have been shown to benefit people struggling with tinnitus.聽They are subtle therapies that require careful understanding and guidance.聽They suggest that much suffering and emotional exhaustion comes from fighting tinnitus (rather than from tinnitus per se).聽

This can be misunderstood as suggesting that the person either learns to like tinnitus or to give up in desperation and defeat. Neither of these is the intention.聽Rather, the idea is that by reducing failing attempts to control or remove tinnitus, the impact of tinnitus also reduces and paradoxically a greater sense of control is achieved. The energy that was maintaining the previous unsuccessful effort at control can then be placed in more life enhancing activity.聽

This does represent a different approach from the pursuit of a cure.聽

The search for a cure

The search for a cure has of course continued over the 40 years of my life in the tinnitus world. Research efforts have gone into finding a pill, and electrical, magnetic, or sound based responses have all received considerable investment.聽Most have produced some benefit for some people and the work goes on.聽It remains the case, however, that the strongest evidence in terms of tinnitus management remains with the CBT approach.

In the late 20^tth and early 21^st century people are often surprised to see a psychologist when attending the hospital for a tinnitus appointment. This is much less the case today. There is a greater understanding and acceptance of the role that psychology plays, not just in our mental health but in our physical health as well.聽

Psychologists are now to be found in a wide range of medical settings such as cancer, diabetes, pain, neurology, women鈥檚 health clinics and in intensive care. Nonetheless, there is still some hesitation to accept a psychological approach in the care of people with tinnitus, as well as in other clinical settings.聽

This hesitation is apparent in some, although much fewer, patients鈥� reluctance to engage in a psychological approach. It is also, however, apparent in the way in which health care budgets are spent. Psychology services for people with tinnitus are few and hard to access. Budgets continue to be spent on services for which there is less robust evidence.聽In this sense not much has changed in 40 years.