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? In this comprehensive guide, we will explore how CBT can help you get your life back.
- 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
Before we discuss how CBT can help, it's essential to understand the nature of tinnitus and its impact on your life.
Root Cause of Tinnitus
Tinnitus is not a disease but a symptom of an underlying issue. It is often described as a phantom sound, as the ringing, buzzing, or hissing is not produced by an external source. The root cause of tinnitus can vary and may include:
- Exposure to loud noise
- Age-related hearing loss
- Earwax blockage
- Ototoxic medications
- Ear or head injuries
- Ménière's disease
- TMJ disorders
- Certain medical conditions, such as high blood pressure or anaemia
In some cases, the exact cause of tinnitus may remain unknown. However, understanding the potential triggers can help you take appropriate steps to manage and alleviate the symptoms.
Living a Normal Life with Tinnitus
Living with tinnitus can be challenging, but it is possible to lead a normal life despite the condition. Many people with tinnitus find ways to adapt to the persistent sounds and carry on with their daily activities. Some strategies that can help you live with tinnitus include:
- Using sound therapy, such as white noise machines or nature sounds, to mask the tinnitus
- Practicing relaxation techniques, like deep breathing, yoga, or meditation, to reduce stress and anxiety associated with tinnitus
- Seeking support from friends, family, or tinnitus support groups
- Implementing healthy lifestyle habits, such as regular exercise, proper sleep, and a balanced diet
Consequences of Untreated Tinnitus
If left untreated, tinnitus can have a significant impact on your quality of life. Some potential consequences of untreated tinnitus include:
- Increased stress, anxiety, and irritability
- Difficulty concentrating or focusing on tasks
- Sleep disturbances, such as insomnia or difficulty falling asleep
- Social isolation, as the constant noise can make it challenging to engage in conversations or social activities
- A higher risk of developing depression or other mental health issues
Given the potential consequences of untreated tinnitus, it's crucial to explore treatment options like CBT to manage the symptoms and improve your overall well-being.
Can CBT Help with Tinnitus?
Cognitive Behavioral Therapy (CBT) is a widely recognized and science-backed psychological treatment that has been proven to help individuals manage tinnitus effectively. Let's explore what CBT is and how research supports its use for tinnitus.
Explanation of Cognitive Behavioral Therapy
CBT is a form of talking therapy that focuses on identifying and modifying negative thought patterns and behaviors to improve emotional well-being and coping skills. It is based on the idea that our thoughts, emotions, and behaviors are interconnected, and changing one aspect can have a positive impact on the others.
In the context of tinnitus, CBT will help you recognize and challenge the negative thoughts and beliefs you have about your condition, ultimately leading to you not being bothered by the sound of the tinnitus any more, and in some cases stopping noticing it completely.
Research behind CBT for Tinnitus
Numerous studies have shown that CBT is an effective treatment for tinnitus. Here are some notable research papers:
- A 2010 study demonstrated that CBT led to significant improvements in tinnitus-related distress, depression, and anxiety. These improvements were maintained at a 1-year follow-up.
- A 2020 systematic review found that CBT was more effective than usual care in reducing tinnitus-related distress and handicap, as well as improving the quality of life of individuals with tinnitus.
- A 2020 meta-analysis confirmed that CBT was effective in reducing tinnitus-related distress, anxiety, and depression, with the effects being maintained over the long term.
These studies, along with many others, provide strong evidence that CBT is the most effective treatment option for tinnitus. By changing how your brain reacts to the ringing sound, CBT will help you manage your tinnitus more effectively and improve your overall quality of life.
Recommendations from Leading Health Organizations
CBT's effectiveness in treating tinnitus has led to its endorsement as the first-line treatment for the condition by several leading health organisations across the globe.
- United States: The American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) recommends CBT as an effective treatment for tinnitus, stating that it can help individuals "manage the stress and anxiety that often accompanies tinnitus, making it easier to live with the condition."
- United Kingdom: The National Institute for Healthcare Excellence (NICE) guidelines for tinnitus management recommend offering CBT to people with tinnitus who are experiencing a significant impact on their quality of life or are distressed by their tinnitus.
- Europe: The European healthcare guidelines for tinnitus management also recommend CBT as an essential component of tinnitus treatment, emphasising its role in reducing tinnitus-related distress and improving patients' well-being.
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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.
For NHS tinnitus treatment, you can ask for a referral from your GP or follow a private healthcare route.
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!