Is Cognitive Behavioural Therapy (CBT) effective in the treatment of tinnitus? Absolutely!
Although there is no cure, we know that some tinnitus treatments can be effective in reducing its intrusion in your life.
CBT for tinnitus is one of these treatments. Numerous scientific studies report how successful it can be in reducing the perception of the ringing in your ears.
So what is CBT and how does it work in tinnitus?
- What is cognitive behavioural therapy for tinnitus?
- Does CBT work for tinnitus?
- How does CBT work?
- What can I expect from CBT?
- How to access tinnitus CBT
- A CBT technique to try
- Oto's tinnitus CBT training
What is cognitive behavioural therapy for tinnitus?
Cognitive behavioural therapy (CBT) is a type of psychological therapy that was originally used to treat to depression, but since then its use has expanded and it's now a validated form of treatment for insomnia, chronic pain, tinnitus and many other conditions.
It works on the basis of understanding any underlying negative or unrealistic thoughts, beliefs or attitudes that are affecting your feelings and actions.
By locating what you think and believe about tinnitus, you can then work to change any unhelpful thought patterns.
In so doing, your response to, and your experience of tinnitus can drastically alter.
Does CBT work for tinnitus?
Cochrane carried out a review of the scientific evidence looking at whether CBT works for tinnitus. It concluded that CBT results in a reduction in the impact of tinnitus, reduced impact on mental health, and improvement in quality of life.
Even though more studies would be beneficial, there has now been enough scientific evidence analysing the effectiveness of CBT to establish it as the most effective and safe treatments for tinnitus.
NICE, the National Institute for Health and Care Excellence, now recommends CBT as the first-line of treatment for tinnitus and tinnitus related distress.
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How does CBT work?
As you probably know, tinnitus is a condition that is usually with us for life.
It can be very intrusive, so it commonly results in the formation of negative thoughts.
It's not as simple as just thinking more positively or trying to ignore tinnitus. Anyone with tinnitus knows that doesn’t work.
Your thoughts have an influence over how you feel and behave. For example, if you’re stuck in traffic and running late it’s easy to worry and become frustrated, even though there’s nothing you can do. If you were to take a breath and think, ‘There’s nothing I can do but wait’, does it change how you feel and behave?
Here's an example of a negative thought spiral that can happen when you perceive your tinnitus:
Neuroplasticity is the brain's ability to learn new thought patterns. The brain is constantly establishing new neural pathways. With CBT, you're able to consciously forge more helpful pathways.
There might be a number of beliefs that you hold about tinnitus. For example:
- I'll never be able to cope with this
- I'm not able to socialise with tinnitus
- No one has tinnitus as bad as mine
- I can't focus because of tinnitus
By identifying these beliefs, you can start to challenge whether they're accurate and true. This, in turn, will affect your thoughts and these then change how you feel, act and physically respond.
Some of the most common unhelpful thought patterns which surround tinnitus include:
- Predicting the future overly negatively
- Fixating on the negative
- Blaming yourself or others
- Denying the reality
- Thinking in an 'all or nothing' way
- Regretting past actions
CBT can help you understand these patterns and then learn cognitive skills to change them.
What can I expect from CBT?
When the brain perceives tinnitus it doesn't understand where the sound is coming from, so it goes into 'high alert' mode.
The primal part of your brain is programmed to pay attention to dangerous and important sounds, like a baby crying, or a siren.
This ‘high-alert’ system pushes adrenaline and other biochemicals through your body in case you need to run, fight or freeze.
Until the brain learns that your tinnitus noise is not the sound of something dangerous or harmful, your body will continue to produce this ‘high-alert’ effect. That is what makes hearing tinnitus so stressful and intrusive to your day to day life and why negative thought cycles are so common.
By consciously understanding the beliefs, attitudes and thoughts around tinnitus you'll be able to teach your brain that this is a sound it doesn't need to give attention: it isn't dangerous. The more your brain is 'fine' with your tinnitus, the less it will draw attention to it, and the less it'll intrude day to day.
Here's an example of a more helpful way to respond to the tinnitus sound you perceive:
CBT can’t rid you of the perception of your tinnitus sound altogether, but it can help you to learn how to habituate by accepting the sound you perceive.
Habituation is the mental process where tinnitus stops bothering you almost entirely and drifts out of your awareness.
How to access tinnitus CBT
CBT is normally offered in individual sessions but can sometimes be offered as group therapy.
CBT is a talking-therapy so it will involve talking to a therapist about different aspects of your tinnitus and how it affects you.
Whilst these sessions will be helpful, they rely on you working hard at the techniques in your own time.
The therapist will equip you with tools and techniques and then you can work out how to best apply these day to day.
There are different ways to seek in-person CBT sessions and professional help with your tinnitus.
Recent guidance recommends digital CBT therapy delivered by psychologists as a good way to treat tinnitus. This is sometimes delivered in combination with mindfulness based therapy.
You might find this more accessible than in-person therapy which is often associated with high costs and long waiting lists.
More work is being done to provide digital CBT for tinnitus management.
A CBT technique to try
One of the first cognitive skills you'll often learn in tinnitus therapy is the S.T.O.P.P tool.
You can try this quick exercise out when you next notice your tinnitus.
It aims to help shift your thought patterns into a more helpful place.
T: Take a breath - in through your nose for 5 counts and gently out through your mouth to the count of 7
O: Observe your reaction
P: Put your thoughts into perspective
P: Practice saying a more helpful thought
The Oto app offers expert guidance to reduce tinnitus intrusion through a variety of resources:
- CBT techniques
- A library of various sound categories such as urban, binaural, ASMR, 3D, sleep, nature, household, and coloured
- Meditation and breathing exercises
- Sleep support including sleep stories, mindfulness for sleep, and sleep preparation
- Exercises to stretch the neck, shoulders, back, jaw, and arms
Check out Oto's Tinnitus Support Group, a supportive community for individuals with tinnitus or related conditions to receive regular tips and tricks from the expert team at Oto!