Cognitive Behavioral Therapy for Tinnitus

What is tinnitus?

Tinnitus is characterized by the perception of a sound in the ears, such as ringing or buzzing, without any external source of sound (Aazh et al., 2019). Although tinnitus can be a symptom of hearing loss in up to 43.2% of individuals (Oosterloo et al., 2021), in the majority of cases, the cause of tinnitus is unknown (Zenner et al., 2013). Tinnitus is a common condition, with between 9% and 40% of individuals in the United States experiencing tinnitus symptoms in their lifetime (Oosterloo et al., 2021).

Despite the frequency of this condition, an estimated 5% to 20% of individuals experience significant impairment in their day-to-day life as a result of tinnitus (Oosterloo et al., 2021). Moreover, research shows a link between tinnitus and mental health difficulties, including anxiety, sleep disturbance, depression, irritability, intense worrying, and subjective distress (Oosterloo et al., 2021). These psychological difficulties can be experienced by individuals with tinnitus, even if tinnitus is not negatively impacting their daily functioning (Oosterloo et al., 2021).

Is there a cure or treatment for tinnitus?

Although chronic tinnitus has no known cure, the condition can be managed through various interventions (Manchaiah et al., 2020). Treatment with an audiologist, medical interventions such as pharmaceuticals, and psychological interventions have all been used in the treatment of tinnitus.

A form of psychotherapy called Cognitive Behavioral Therapy (CBT) is an effective and research-validated approach to helping individuals manage the auditory and psychological symptoms associated with tinnitus, including annoyance and distress (Manchaiah et al., 2020, Andersson 2002, Hoare et al., 2011, Hesser et al., 2010). CBT is also an evidenced-based treatment for some of the mental health challenges that may co-occur with tinnitus, such as anxiety, depression, and insomnia (Andersson, 2002).

What is CBT?

Cognitive Behavioral Therapy, or CBT, is a type of psychotherapy that combines techniques and interventions from both behavioral and cognitive therapies. Dr. Albert Ellis is considered the father of CBT, which has been well-validated in research to address a variety of mental health challenges. In general, CBT is based on the premise that thoughts, feelings, and behaviors have a reciprocal influence on each other.

When an external event (such as an interpersonal interaction) or internal event (such as a thought or feeling) occurs, it is our own interpretation of the event that leads to our response. According to cognitive behavioral theory, individuals may have faulty belief systems that can lead to patterns of distressing behavior. These faulty belief systems can lead to negative views of oneself, the future, and the world. In CBT, a client works with a therapist to build skills to help manage distressing thoughts, feelings, sensations, and urges.

In addition, CBT helps individuals gain insight into their own thinking processes and dysfunctional belief systems in order to respond to life’s stressors in more adaptive ways. This, in turn, helps lead to a reduction in psychological distress and self-defeating patterns of behavior (Beck, 2011). In other words, CBT helps individuals think about their thinking and apply new skills in order to facilitate positive emotional and behavioral change.

CBT is generally a time-limited form of psychotherapy. Individuals set goals in conjunction with a therapist, and treatment is present oriented and problem-focused (Beck, 2011). The techniques utilized by one’s therapist and the emphasis of treatment will depend on the client’s unique challenges, as treatment is highly individualized. Homework is a common component of CBT, and it is utilized to provide clients with the opportunity to practice new skills between sessions. 

Is CBT one of the most effective treatments for tinnitus?

Research tells us that CBT is well validated as a treatment for tinnitus, with a number of controlled studies providing support (Andersson, 2002). Although CBT does not decrease the volume of noise from tinnitus, it has been shown to decrease the annoyance and distress that the condition can cause (Andersson, 2002).

In addition, one study demonstrated that post-treatment, individuals who received CBT for tinnitus continued to experience an increase in tolerance of tinnitus and a decrease in annoyance from symptoms (Andersson et al., 2001). Another study found that CBT treatment that specifically addressed tinnitus can be an effective form of therapy for individuals experiencing chronic tinnitus (Zenner et al, 2013).

In a large review of studies that all examined tinnitus management strategies, therapist-delivered CBT was found to be an effective treatment according to the existing research (Hoare et al., 2011).

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How long is CBT treatment for tinnitus?

The course of treatment of CBT treatment for tinnitus will vary depending on the symptoms experienced by the client. CBT treatment is generally short-term. One study demonstrated that CBT treatment was effective in as little as 6-10 sessions (Andersson et al., 2001). However, if tinnitus co-occurs with another mental health condition, such as anxiety, depression, or insomnia, treatment may take longer.

In this case, CBT would focus on both tinnitus and the additional symptoms. Research suggests that improvements made during CBT treatment for tinnitus last after treatment ends (Andersson 2002, Andersson et al., 2001). Therapists will work with clients to determine the appropriate length of treatment. In addition, the therapist will do an ongoing assessment of the client’s symptoms in order to adjust treatment as needed.  

How can I find a CBT therapist in NYC?

Although it can be overwhelming to know where to begin, starting with the right website can help. Referrals for a CBT therapist can come from schools, primary care physicians, and targeted internet searches. If you speak with a therapist and they do not seem like a good fit, they may also be able to provide you with a list of additional referrals.

A good fit between client and therapist is important for therapeutic success, and many therapists will offer a free consultation to see if they are a match for the type of support you need. At New York Behavioral Health, all of our therapists have training in CBT and will work with you to complete an assessment to gain a deeper understanding of your experiences and formulate a plan to help you achieve your goals. 

What kind of CBT interventions are used at New York Behavioral Health?

CBT is an evidence-based treatment that has been shown to be successful with a wide range of challenges, including tinnitus. Therapists at NYBH individualize treatment and will select techniques that target specific symptoms and skill areas for each client. Mindfulness is a technique that can be incorporated into sessions in a number of ways. The goal of mindfulness is simply to allow oneself to notice the present moment, without judgment.

Clients are taught to interact with their thoughts and emotions with curiosity, which provides space for approaching situations with a thoughtful response. Another technique that may be utilized is cognitive restructuring. This technique is a process in which the therapist supports the client in identifying faulty patterns of thought. Clients learn to increase their awareness of their own thoughts, evaluate their thoughts, and replace them with more adaptive thoughts.

Sometimes this process involves keeping a thought record, or a structured log of situations/triggers, thoughts and responses. Each therapist at NYBH will utilize homework assignments so that the skills introduced in sessions can be practiced in the real world. Homework will be discussed in session to evaluate progress and provide information about any needed adjustments to treatment. By completing homework assignments, clients learn how to apply knowledge gained in therapy to create change that lasts beyond the course of treatment. 

References

Aazh, H., Bryant, C., & Moore, B. (2019). Patients’ perspectives about the acceptability and effectiveness of audiologist-delivered cognitive behavioral therapy for tinnitus and/or hyperacusis rehabilitation. American Journal of Audiology28(4), 973–985. https://doi.org/10.1044/2019_AJA-19-0045

Andersson G. (2002). Psychological aspects of tinnitus and the application of cognitive-behavioral therapy. Clinical Psychology Review22(7), 977–990. https://doi.org/10.1016/s0272-7358(01)00124-6

Andersson, G., Vretblad, P., Larsen, H. C., & Lyttkens, L. (2001). Longitudinal follow-up of tinnitus complaints. Archives of Otolaryngology–Head & Neck Surgery127(2), 175–179. https://doi.org/10.1001/archotol.127.2.175

Beck, J. S. (2011). Cognitive therapy: Basics and beyond (2nd ed.). Guilford Press.

Hesser, H., Weise, C., Westin, V. Z., & Andersson, G. (2011). A systematic review and meta-analysis of randomized controlled trials of cognitive-behavioral therapy for tinnitus distress. Clinical Psychology Review31(4), 545–553. https://doi.org/10.1016/j.cpr.2010.12.006

Hoare, D. J., Kowalkowski, V. L., Kang, S., & Hall, D. A. (2011). Systematic review and meta-analyses of randomized controlled trials examining tinnitus management. The Laryngoscope121(7), 1555–1564. https://doi.org/10.1002/lary.21825

Manchaiah, V., Vlaescu, G., Varadaraj, S., Aronson, E. P., Fagelson, M. A., Munoz, M. F., Andersson, G., & Beukes, E. W. (2020). Features, functionality, and acceptability of internet-based cognitive behavioral therapy for tinnitus in the United States. American Journal of Audiology29(3), 476–490. https://doi.org/10.1044/2020_AJA-20-00002

Oosterloo, B. C., de Feijter, M., Croll, P. H., Baatenburg de Jong, R. J., Luik, A. I., & Goedegebure, A. (2021). Cross-sectional and longitudinal associations between tinnitus and mental health in a population-based sample of middle-aged and elderly persons. JAMA Otolaryngology– Head & Neck Surgery147(8), 708–716. https://doi.org/10.1001/jamaoto.2021.1049

Zenner, H. P., Vonthein, R., Zenner, B., Leuchtweis, R., Plontke, S. K., Torka, W., Pogge, S., & Birbaumer, N. (2013). Standardized tinnitus-specific individual cognitive-behavioral therapy: A controlled outcome study with 286 tinnitus patients. Hearing Research298, 117–125. https://doi.org/10.1016/j.heares.2012.11.013

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