Cognitive Behavioral Therapy For Tinnitus

Sound therapy for tinnitus is frequently considered tantamount to a physical tinnitus treatment addressing the ear or inner ear, but there are other types of therapy that can help reduce tinnitus related distress and recover some semblance of mental health following tinnitus diagnosis and subsequent tinnitus management. Does Cognitive Behavioral Therapy for tinnitus truly work as a form of treatment?

What Is Cognitive Behavioral Therapy?

Cognitive Behavioral Therapy (also called CBT) is one kind of psychotherapy that focuses on the relationship between our thoughts, emotions, and behaviors. According to the Cleveland Clinic, CBT is known to be an effective treatment for a variety of problems, including mental health issues (e.g., depression, anxiety, post-traumatic stress disorder), other health conditions (e.g., fibromyalgia, migraines, tinnitus), and other life stressors (e.g., relationship issues, grief, work problems).

CBT is an evidence-based treatment in clinical psychology that promotes the development of coping skills and often results in significant improvements in an individual’s overall quality of life–including when it is used as one prong of a larger tinnitus treatment plan.

How Does Cognitive Behavioral Therapy Work?

According to the American Psychological Association, a goal of CBT is to change a person’s thought patterns. This is helpful for people who develop problemed thought patterns with relation to tinnitus. They must first identify that the thought pattern is not helpful or productive, and then develop strategies to change it such as calming their thoughts and body, preparing for interactions with others, and facing their fears.

Here is a CBT example provided by the National Institutes of Health: you see somebody you know on the street and say hello, but they do not say hello back. Your reaction will depend on your thoughts and feelings, which drive your behaviors. If your thought is, “they ignored me” or “they don’t like me anymore,” you may feel sad and rejected, leading you to avoid that person in the future. If your thought is, “they didn’t notice me–maybe they don’t feel well. I should give them a call and find out how they are doing,” you likely will not attach any negative feelings to this person and ultimately reach out to them. The important thing to note here is that the source of distress is not the event itself, but the reaction to it. Negative thoughts are reframed and reduced in this type of cognitive therapy to reduce stress and suffering.

Here is another CBT example with which many people may relate: Let’s say you are at home reading a book on your couch and hear creaking from the floorboards in the hallway. If you live with other family members and know that your son John is home, your thought is likely to be, “Oh, there’s John. He must be coming downstairs to get a snack.” No negative feelings will result and you will continue reading. If you live alone and are not expecting company, your thought may be, “Someone is in the house. I’m in danger.” Negative feelings such as fear or anger are likely to flood your body and you will leap up from the couch, ready to fight or flee.

CBT can help you identify thought patterns that are not based in reality and are unhelpful, change them into positive thoughts, improve your reactions in the present moment, and hopefully reduce distress over the long term. In addition, CBT often incorporates strategies such as imagery techniques, relaxation training, reframing, deep breathing, and other problem solving strategies to successfully ease stressors and pain–including for tinnitus patients.

How Can Cognitive Behavioral Therapy Help With Tinnitus?

Although it is not considered a cure for tinnitus, research has studied the effects of CBT on tinnitus for many years and there is strong evidence supporting its use in this context. One common goal of managing bothersome tinnitus is “habituation” (the process of decreasing a response to a stimulus over time). Researchers have determined that negative thoughts and feelings about tinnitus prevents someone from achieving habituation. As such, if CBT is able to aid a person in identifying and changing negative thoughts and feelings about tinnitus, a person’s reactions are likely to improve. Over a longer period of time, CBT may promote habituation.

While audiologists can employ research-supported strategies such as education (empowering patients to understand their tinnitus) and sound therapy (reducing awareness of tinnitus), CBT can improve a person’s reaction to tinnitus.

To Whom Should I Go For Cognitive Behavioral Therapy?

Although CBT alone is not the most effective treatment for tinnitus, if you wanted to incorporate CBT as part of your treatment program (along with sound therapy and directed counseling from a tinnitus audiologist), a psychotherapist (for example, a clinical psychologist) is likely to be the most appropriate. You may also ask your Primary Care Physician or audiologist for recommendations, as they may have experience working with local CBT providers in your area, or you can search your state psychological association website for providers.

Although a psychotherapist is likely to have the training necessary to provide the full CBT   experience, audiologists with appropriate training may also contribute to a patient’s success with CBT concepts.

Some patients may also choose to pursue online options, which allow them to register for a program that includes online modules designed to manage their tinnitus-related distress. Others may use tinnitus interventions that combine CBT for tinnitus and audiologists, which has also demonstrated promising results.

Should CBT For Tinnitus Be Used On Its Own?

While behavioral treatments are helpful to manage tinnitus, chronic tinnitus will likely require a more progressive tinnitus management regimen that includes several different approaches. Cognitive behavioral treatments are likely to work best when they are used as part of an overall treatment plan for tinnitus patients. Chronic tinnitus is often treated with some form of CBT, including mindfulness based cognitive therapy, in addition to hearing aids, relaxation techniques, a tinnitus assessment to target any root causes, and avoidance of further stressors. Cognitive restructuring helps with the mental aspect of the condition to reduce tinnitus distress, while other approaches may focus more on chronic pain, physical therapy, or the physical aspects of the condition rather than the psychological aspects or emotional response tinnitus sufferers have.

Other Approaches For Tinnitus Management

There are numerous options that can be used to address symptoms of tinnitus. Treating tinnitus, after all, involves far more than simply searching for a lingering ear infection or noise exposure and moving on; instead, it requires digging deeper into possible causes and subsequently tailoring a program to fit an individual’s needs. Some of the most common approaches include:

• Mindfulness based stress reduction. Stress reduction is often seen as a valuable addition to a treatment plan, because stress can negatively impact audiological function. Mindfulness does not help people ignore tinnitus, but can help soothe the anxiety and fear that can spike following a flare of symptoms.
• Psychological and behavioral therapies. Behavioral therapy for tinnitus is predicated on the idea that much of the suffering associated with tinnitus is a spike of fear or stress in response to symptoms. Mental health interventions can function as a highly effective treatment in managing flares and spikes caused by anxiety, depression, and other mental health concerns.
• Addressing hearing loss. Hearing loss is a concern that can be targeted by ear, nose, and throat doctors and audiologists, both of whom will be more likely to have experience working with and understanding tinnitus. Although these professionals do not have definitive cure for hearing loss, addressing the root issues of hearing loss can often help lessen tinnitus symptoms, and may even help with some of the anxiety that accompanies a diagnosis. Hearing loss can occur from an external source or an internal one, but both may be able to have some form of therapy or treatment to address the issue.
• Addressing background issues. Sleep problems, ongoing exposure to loud noises, existing disorders and more can lead to tinnitus development. By addressing these issues, symptoms may lessen. When symptoms lessen, depression and anxiety symptoms may decrease, and quality of life may improve.

As the different treatment options above can attest, there is no single treatment option for tinnitus that is used to address the condition entirely. Instead, tinnitus today is targeted using a multi-pronged approach that views treatment as an ongoing process rather than a single-minded destination.

Conclusion

Tinnitus Retraining Therapy (TRT), hearing aids, CBT, and more can all be used in conjunction to deliver the best tinnitus management plan for those with both chronic and acute tinnitus symptoms. Some of the best programs for addressing tinnitus distress include both CBT and Tinnitus Retraining Therapy, in addition to any other targeted treatments, to reduce tinnitus distress and effectively treat tinnitus. Individuals who practice CBT exercises and thought processes may develop cognitive skills to better manage any additional symptoms that accompany the condition, such as mental health deterioration, and can improve quality of life and significantly reduce tinnitus distress.