Mindfulness Based Tinnitus Stress Reduction
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Mindfulness Based Tinnitus Stress Reduction
By: Dr. Jennifer J. Gans
This article is written to encourage those suffering with tinnitus to turn to their internal resources for the answer.
Most people have experienced a brief ringing in the ears after a loud concert or a moment of silence. For most, this sound fades quickly—quietly canceled by the brain’s internal filters. But for millions of people, tinnitus does not fade. It becomes intrusive, persistent, and unnervingly loud, even though the sound itself poses no physical threat. What separates fleeting, ignorable tinnitus from bothersome tinnitus is not the ear—it is the brain’s failure to cancel an otherwise harmless signal.
Tinnitus is a benign internal body sensation—most often a hissing, tonal, or soft electrical signal—that the brain mistakenly interprets as important. It is not a disease, and it is not dangerous. Tinnitus arises when a person experiences hearing loss (for some this is noticeable hearing loss and for others it is simply expected hearing loss with age). When hearing is diminished, the brain searches for the sound/frequency that it is no longer able to perceive. In this excitatory search, the brain fills in the missing sound resulting in what is called tinnitus. For most people, tinnitus is not linked to fear and the brain quickly learns to ‘cancel’ the sound. However, for those reporting bothersome tinnitus, the brain detects this new, unfamiliar sound, classifying it as a danger, something unexpected that requires attention and close monitoring. Especially during times of fear, fatigue, or heightened stress—the sound gets mislabeled as relevant and threatening. This misclassification, not the sound itself, is what keeps tinnitus in conscious awareness.
Imagine if the brain had no way of filtering relevant from irrelevant stimuli. Imagine if the brain treated every sensation with equal importance. To prevent sensory overload, the brain has a ‘triage system’ where it conveniently filters out predictable, consistent and irrelevant sensations.
When you first put on a shirt—or even a watch, ring, glasses, or socks—you feel it very clearly.
Within seconds or minutes, the sensation disappears from awareness.
Because the touch receptors continue sending signals, but the brain decides the sensation is predictable, continuous, and not important, so it cancels the signal from reaching conscious awareness.
You aren’t “blocking” the sensation. The sensation is still happening—but the brain is filtering it out so you can focus on more relevant information.
Most people aren’t aware of their own breathing unless they think about it. Yet the chest rises and falls all day long. The brain cancels this rhythmic, predictable (even ‘boring’) internal sensation—until you suddenly pay attention, and it comes rushing back into awareness.
In a hospital setting, triage refers to the prioritization of patients based on the urgency of their medical needs. Similarly, the brain has a natural “triage system” centered in the amygdala, which serves as a primal threat-detection center. This system is designed to rapidly identify potential dangers based on instinct and past experience, allowing the body to respond quickly and protect itself.
The brain also relies on prediction to decide which sensations are important and which can be safely canceled. After stress, trauma, illness, or hearing changes, this system can become disorganized. When that happens, a prediction error may occur, and the brain can mistakenly elevate the importance of tinnitus—treating a benign signal as though it requires urgent attention.
When a sensation is tagged as frightening, frustrating, or fascinating, fear centers in the brain bring the stimuli into conscious focus. (see https://mindfultinnitusrelief.com/downloads/Gordian_Knot_Article.pdf for an in depth description) For many, this cancellation system downgrades tinnitus into the background. When it fails, tinnitus is instead kept in the foreground, treated as a clear-and-present danger, your mind gets ‘stuck’, and tinnitus bother follows.
Instead of being labeled by the brain as ‘boring’ thus fading into the background, tinnitus is:
If tinnitus is interpreted as threatening, the limbic system activates, increasing arousal. The amygdala tags a sensation as relevant, and in the case of tinnitus this misclassification leads to persistent awareness.
This creates a feedback loop:
1. Notice tinnitus
2. Fear/Danger Reaction
3. Anxiety rises
4. Attention/Vigilance increases
5. Tinnitus bother increases
6. Cancellation System Failure Failure
The brain’s cancellation system can fail whenever its prediction and filtering networks are disrupted. Stress, trauma, hearing changes, illness, or sudden increases in cognitive load can all make the nervous system more vigilant. When this happens, the brain becomes less confident in its internal predictions and is more likely to treat neutral signals—like tinnitus—as errors requiring attention.
In other words: the brain stops trusting its own “all clear” message, and harmless sensations like tinnitus suddenly feel important, urgent, or threatening.
If you are reading this article and you have bothersome tinnitus or know someone who does, take a moment to think about your/their personality.
People with bothersome tinnitus are vigilant. For example, they scan the environment around them and if they spot a problem, they pounce on it and will not let it go until they figure-it-out. They are often obsessive in how they go about certain things. These people ‘don’t miss much’ and they are alert and aware to the potential dangers around them.
This amazing personality style is quite adaptive in many areas of life (ie., at work, in keeping themselves and those around them safe). However, especially under times of cognitive chaos, the brain runs the risk of mislabeling stimuli as a threat. Stories (ie., maybe I have a brain tumor, this means I will lose my hearing, this is all my fault for the loud music I listened to as a kid, no one can help me, to name a few…), get tightly wrapped around the sensation of tinnitus keeping them “stuck” in a tinnitus-awareness loop.
Anxiety is the fuel that keeps tinnitus burning. Heightened arousal keeps the salience network active, making cancellation more difficult. The anxiety that goes along with a history of trauma sensitizes the threat-detection circuits, increasing vigilance toward internal sensations.
When talking about the effective path to shifting tinnitus from bothersome to non-bothersome there are three necessary ingredients: 1) Accurate Education, 2) Reduction of tinnitus anxiety, 3) Stress Reduction.
Without accurate education, the brain is doomed to mislabel this benign body sensation as relevant, impairing the brain’s natural cancellation system. Humans function better when we understand. Without accurate education, we run the risk of creating fear stories that keep the ‘lens of the mind’ locked-and-loaded on tinnitus. Even when what lies ahead is unpleasant, with education, we can plot a path to healing. Education helps us to create space so that instead of ‘reacting’ to tinnitus in old dysfunctional ways, we can begin to ‘respond’.
Everyone with bothersome tinnitus by definition is experiencing heightened anxiety. Anxiety creates the vigilance to the sensation. Anxiety wraps tinnitus up in a Gordian Knot of stories keeping the mind stuck (see https://mindfultinnitusrelief.com/downloads/Gordian_Knot_Article.pdf).
Approaches such as Mindfulness Based Tinnitus Stress Reduction (MBTSR; MindfulTinnitusRelief.com), cognitive-behavioral strategies, accurate education and when anxiety is extreme, medication, all help to reduce the anxiety keeping the brain stuck. A combination of these tools helps to restore the brain’s balance and ability to “respond to” rather than repeat old unhelpful “reactions”.
The ultimate goal for anyone who is caught in the tinnitus-salience-loop is to find a way to make the tinnitus sensation boring to the brain. Once the brain tags a sensation as boring and irrelevant, the sensation is released from attentional focus and can drift into the subconscious where it belonged from the start. Luckily, the brain’s cancellation system is highly plastic meaning it can reclassify a sensation. Tinnitus management falls into a spectrum from 0 to 100. Zero is education. Without Zero you cannot go further. Once accurate tinnitus education is established, you then have from 1 to 100 different tools at your disposal to help shift tinnitus from bothersome to non- bothersome. The range is vast and all are in the service of reducing anxiety. A combination of many tools (using sound to calm the brain all the way to 100 which is medication) puts you on the path to healing.
Bothersome tinnitus is not caused by the loudness of the sound but by the brain’s interpretation and subsequent vigilant focus. When the brain learns that tinnitus is safe, unimportant, and frankly, boring, its natural cancellation system resumes its work—and tinnitus goes where other benign body sensations go—out of our conscious awareness.
1. https://MindfulTinnitusRelief.com
2. Rauschecker, J. P., et al. "Tinnitus and the Brain’s Noise-Cancellation System." Cell.
3. Gans, J.J. Mindfulness Based Tinnitus Stress Reduction: Unraveling the Gordian Knot of
Tinnitus. https://mindfultinnitusrelief.com/downloads/Gordian_Knot_Article.pdf
Dr. Jennifer Gans, Psy.D.
Clinical Psychologist | Founder, MindfulTinnitusRelief.com
Creator of the Mindfulness-Based Tinnitus Stress Reduction
(MBTSR) Program