Listening to and monitoring tinnitus
A PERSONAL EXPERIMENT by Debbie Featherstone
Who is CBT4T Substack for?
The aim is for the CBT4T Substack to be a useful resource to anyone interested in CBT (Cognitive Behaviour Therapy) and how it is used in the CBT4T programme. As such, it is for:
Anyone who supports others who have tinnitus, such as Audiologists, Hearing Therapists, and those in a tinnitus supporting/advisory role
Anyone with troublesome tinnitus & interested in Cognitive Behaviour Therapy (CBT) & related Neuroscience, including when already enrolled in the CBT4T programme
Today’s post is an article previously published in the CBT4T Bulletin 18th March 2020 (www.tinnituseprogram.org) updated with a short final section “Five Years On”
Listening to and monitoring tinnitus
I chose a weekend to MONITOR my tinnitus. Just to observe what it did in terms of loudness. I used a simple scale of 1-10, 1 = very quiet, and 10 = as loud as I believe it can possibly be.
Something I find really interesting is....
When I happen to mention to patients that I too have tinnitus, they are often quite surprised. Mine began in 1993 and hasn't stopped since. Lucky for me I knew what it was (once I'd sussed it wasn't a noise from "outside") and I never attached any emotion to it. I wasn't scared of it, I didn't "hate" it - it was just something that was there that I'd prefer wasn't, but as there was nothing I could do other than ignore it, that's what I did.
As a result, I became one of the 85% (of the 1 in 10* of the population who has tinnitus), and 'habituated' to it being there, unnoticed most of the time. It is a different story for 15%, who struggle to live with tinnitus.
*At the time of writing, prevalence was reported as 1 in 10 of the population has tinnitus. In 2025 according to Tinnitus UK, prevalence is 1 in 7
A commonly learned prediction that many people form and use daily is that on waking, if their tinnitus is "loud" - it means (to them) they are in for a bad day; whereas if the noise is “quiet” – it means (to them) they might have a better day, but it wouldn't last.... and sure enough, their 'prediction' usually came true.
On-waking monitoring > predicting is VERY common, and of course leads to more frequent monitoring, that becomes habitual (habit-formed). It is a typical element of maladaptive neuroplasticity discussed in a previous CBT4T Substack: How you got here
Monitoring (listening for and listening to) tinnitus is frequently the last habit behaviour that changes (changing from maladaptive > adaptive neuroplasticity) by the end of a habituation process.
I decided to carry out a personal experiment. I can't think why I had never thought of doing it before, but sometimes these ideas come to us, and we wonder "why didn't I think of this before?"
THE EXPERIMENT
I chose a weekend, a time of the week for me that has less likelihood of there being any unexpected stress around, to MONITOR my tinnitus. My intention was just to observe what my tinnitus did in terms of loudness. I used a simple scale of 1-10: 1 = very quiet, and 10 = as loud as I believe it can possibly be.
First day - Saturday 25 January 2020:
12:30pm: Tinnitus loudness: 3/10 Mainly left ear and head
I have no more entries for the Saturday because I forgot to monitor it!
Second day - Sunday 26 January 2020:
09:55am: Tinnitus loudness: 6/10 Left and right ears, and head with pulsing
15:15pm: Tinnitus loudness: 8/10 Left and right ears, and head; piercing
17:50pm: Tinnitus loudness: 4/10 Left and right ears
21:55pm: Tinnitus loudness: 7/10 Left and right ears
Prior to this mini-experiment, I had been aware that my tinnitus varied in loudness, but my assumption was it varied day-to day. I hadn’t realised how much it varied throughout a day. As I mention above, being one of the 85% having tinnitus but not bothered by it, my mind has no reason to think of it most of the time, so I don’t hear it most of the time.
The experiment had shown how much variability there was with my own tinnitus! In fact, a thought popped in to my head when I did the 15:15 monitoring..... "How on EARTH was I NOT noticing that?????" It was so shrill and piercingly LOUD!
I had recorded those results, and must admit, it did cross my mind at the time "I hope this doesn't trigger me off "monitoring"!
And indeed, as belatedly anticipated, the experiment DID have an after-effect. It wasn't until 4 days later - the Thursday - that I realised I had stopped monitoring! Monday and Tuesday, my mind kept thinking about the tinnitus, Wednesday less so, and I realised on the Thursday evening that I hadn't thought about it all day - other than the usual times which is when I am talking to a patient about their tinnitus, and I do occasionally internally-relate to my own - which causes me to notice my tinnitus.
I don't "notice" when I stop noticing of course! It's not until the next time I "notice" it, I realise I've not noticed it.... That's just the way it works!
This after-effect led me to consider why it takes a long time for the patients to 'stop monitoring'. I only did it for a day, and it took 4 days to stop monitoring. Plus, I really don't care about 'my tinnitus'.... I consider myself one of the 85%, fully habituated and although I have tinnitus, it has no effect on my life. Other than occasionally tinnitus having been a good teacher that over the years has allowed me to be cognisant of what it is to experience a 'phantom noise', by which I mean a noise that I can hear, but has no external source of origin.
And lucky for me, because tinnitus has never carried any strong negative meaning for me, I don’t care about it. My mind doesn't care about it, has no interest in what it's doing, doesn't go in to overdrive or overwhelm about it.
27 years later, I look back at a career that has been spent helping others to achieve what came so easily to me. They have had to work harder than I ever did to change, but change they have, and they continue to do so. That career has been my share in helping "the 15%" become part of “the 85%” which, of course, is why I still do it!
Five Years On
It’s now July 2025 - five years on from the self-inflicted experiment. I have never been tempted to repeat the experiment and I would seriously caution anyone against experimenting themselves! I did it before I had the level of understanding that I have now about neuroplasticity.
However, I learned two main things that I have since been able to pass on to others:
Other than a very few exceptions, one being when tinnitus has been caused through whiplash injury, where impacting a nerve in the neck results in an unchanging loudness level of tinnitus, tinnitus varies A LOT - both in loudness (how loudly we perceive it to be) and in what it sounds like. There is what might be referred to as a baseline i.e. what it usually sounds like, such as a hiss, or droning, or whistling… (there are many different tinnitus sounds), but it can and does vary in loudness and in the sound itself. If you are interested in understanding more about ‘What does tinnitus sound like’, the Tinnitus UK website is a great place to start! There is also a recording of synthesised tinnitus sounds in a previous CBT4T Substack 8th June 2025
I spent ONE day monitoring my tinnitus, and it wasn’t until FOUR days later that I had stopped. And I was not stressed, I had no anxiety, I wasn’t depressed, worried or fearful. Everyone coming to the CBT4T programme has already had tinnitus for a significant length of time. A few find the programme early-on either through Tinnitus UK or an internet search; however, well over 90% of those coming to CBT4T have been struggling for many months, and indeed, years when they enrol. Most also have significant stress, and anxiety; they are often fearful and worried, and sometime feel low, even depressed. As brilliant as neuroplasticity is, and as certain as it is that maladaptive-neuroplasticity is changeable to adaptive-neuroplasticity through repeated practice, changes won’t turn around in a few days. The process to bring about adaptive-neuroplasticity is a PROACTIVE process, undertaken stage by stage over time as set out in the CBT4T process. The average time taken from start to finish is 6-8 months; as a rule of thumb, the lower the initial TFI category (Tinnitus Functional Index), the less time it is likely to take.
Thanks for reading! I hope you’ve found the article helpful.
PLEASE do comment below - I can only know if you are finding the content I’m publishing here in the CBT4T Substack interesting if I hear from you!
CBT4T Programme
To view the CBT4T full programme Outline: https://courses.tinnituseprogram.org/cbt4t-2025
Recordings - A new section for CBT4T
New Progressive Relaxation with Debbie Featherstone: https://courses.tinnituseprogram.org/progressive-relaxation-with-debbie-featherstone
CBT4T Packs for Professionals
To view CBT for Tinnitus Distress for Audiologists and Hearing Therapists https://courses.tinnituseprogram.org/cbt-for-tinnitus-distress
To view CBT for Tinnitus for Advisors & Support Workers (soon to be updated) https://courses.tinnituseprogram.org/tinnitus-advisors
29th July 2025
Great stuff Debbie. Well I didn't realise you too had tinnitus but this just gives me even more faith in your course! I will not be monitoring but am so aware that my tinnitus varies a lot.
Interesting article thanks for sharing.