Why CBT Hurts Our Cause

The most common form of tinnitus "treatment" is Cognitive Behavioral Therapy, which aims to reduce negative thought patterns and improve quality of life. While CBT does appear to reduce stress in the majority of tinnitus patients, there are several striking limitations to its use. For starters, not everyone has the time or money to afford CBT. Second, it likely does not address all abnormalities in the chronic tinnitus brain. EEG patterns (brain waves) are abnormal for chronic tinnitus patients. Tinnitus distress causes abnormal patterns in the frontal lobe while tinnitus intensity and cognitive impairments occur in the temporal lobe. To my knowledge, CBT seems to correct the frontal lobe abnormalities but not the temporal lobe abnormalities.

Chronic tinnitus patients also suffer from impaired sleep EEG scores, having less deep slow wave sleep. CBT does not appear to correct this either. And yet, CBT seems to be the fall back of clinical practitioners everywhere. Most of the time, ENTs are worthless and unable to help the patient, so they send them to get CBT or TRT since they do not have any answers.

And therein lies my problem with CBT and other similar interventions. They give clinicians an easy out, and allow them to improve mood and well being without actually addressing the problem in the first place. By accepting CBT, you become content with tinnitus and there is less pressure for find a cure. I mean, why use resources on that when CBT corrects everything right? This is partially why I refuse CBT, even if it improved my quality of life dramatically. I refuse to be another "success story" that ENTs can turn to when we demand a cure for this wretched condition. I am by no means asking others to forgo treatment, but please do not allow a calmer existence to let you forget about the need for a cure. A small minority of people do not benefit from CBT, and for those like myself who refuse it, we are left waiting for a cure.

I shall settle for nothing short of that. We need not allow interventions that improve stress coping and well-being to throw us off target.

 

CBT is literally the only effective treatment we have to cope with tinnitus. It doesn't help with the level of sound, but it helps with how we deal with it. It will allow us to cope until something else comes. It is not a cure or a treatment for tinnitus. It is a treatment for the symptoms of tinnitus, such as anxiety and depression.

 

I understand your pain! As someone that lives with beyond intrusive tinnitus and horrible hearing loss as well....I'd love to see a cure that can help my ears hear better and to not have this demon whistle out my head 24-7! This site and quite a few other sources are advocating for a cure all the time. People are doing their parts to find a cure, people are working on it.

Things such as TRT, CBT are not meant to cure tinnitus. They are used to help us live life a little better (even if we have loud tinnitus or mild tinnitus). Tinnitus is a rotten deal and it can affect many good people and change their lives. I will use any tool, trick, technique that will help me live a better life! I was blessed to have done TRT treatments about 26+ years ago, it was a blessing for me. I have not done CBT treatments, but I have been open about my struggles in my life and have talked it out with those that truly loved me and still love me.

All of this requires LOTS of effort, I can't hear too well and the siren of hell that is in my head can make life very hard. it's a hard life, but I have a huge heart and I have TONS of motivation to not let my obstacles stop me from doing my best in my life. I never had it easy in my life and pain has been a badge that I wear all the time. I still want to live my life,do my best..... whether these damn ears ring or whatever.

Do look for a cure and I hope we find it. At the same time don't slam things, that can help make life a little easier for those that have tinnitus. Every little thing that can possibly help us, with this dreaded ordeal is always a huge plus
in my books!

PS-The MIND is the biggest asset, we have to stand up to our afflictions!

 

Well said @fishbone

CBT, TRT and any other known tinnitus treatment to be effective in improving a person's quality of life, I advise people reading this thread to try if possible, especially if the tinnitus is problematic. This also includes medication such as Antidepressants and benzodiazepines. Tinnitus is just one of many medical conditions for which a cure hasn't been found yet. I have had TRT twice with good results. In many cases tinnitus can be improved with
counselling and where necessary medication and sound therapy. It is what is available at present until a cure can hopefully be found.

The alternative to not pursuing medical treatment, if tinnitus becomes severe is often misery and discontent. If one isn't careful, their mental health can start to deteriorate, which may require them to be eventually hospitalised.

Michael

 

What if you do not have anxiety and depression? You have torture.

 

But coping could still mean being unable to work, socialize or pretty much to have a decent life. If you're in that group, it's understandable if CBT isn't enough. Also, many misconceptions are currently being spread due to the way CBT for tinnitus is being promoted and how the people offering it talk about it. A good example are the two recent podcast episodes by the ATA or the new European guideline.

 

Nailed it, it's pretty much what I've been saying for years.

 

I agree with the general cut of your jib, which is that we need effective treatments and not more palliative options, and I also think that CBT is pretty well understood now, so I'm somewhat sympathetic to the idea that it's not necessarily something we should be prioritizing tinnitus treatment dollars towards, even though I do think it's still a good thing to be studying in general. That said, I disagree with a few things pretty strongly.

Oh?

https://www.ncbi.nlm.nih.gov/pubmed/15560773

This is logical, since people in distress states in general sleep more lightly, it's a basic function of the autonomic nervous system.

I don't see an "easy out"; I see compassionate caregivers trying to do anything to improve the lives of people with a medically refractory condition. This isn't a case of choosing one tool over another, right now this is the main thing in the toolbox that reliably shows quality of life improvements in some substantial subset of the tinnitus population.

This seems to be a logical fallacy; you spent paragraphs explaining why CBT doesn't correct everything (which clinicians are well aware of). I don't think there's ever been more pressure, or money, or research behind novel medical treatments for HL and tinnitus -- this in spite of the prevalence of CBT.

So, cutting off your nose to spite your face? That never makes sense.

I want a real cure just as much as you do; I've spent hundreds of hours and many thousands being a lab rat in this study and that. In the mean time I will lean on whatever tools I have to maximize my quality of life and minimize my distress, and if that means CBT and meditation and medication, alright, that's what I'm doing because every time the second hand ticks, it's a moment I'm not getting back.

I also find it somewhat in congruent when threads like this come from people who haven't tried the techniques and beyond that refuse to, obstinately, for reasons which don't seem to make much sense.

I also question this. Yeah, the optimal situation is a compassionate, experienced practitioner, and not everyone can afford weekly therapy or whatever. There's nothing "magic" about CBT, though -- it can be learned pretty effectively in the Mindfulness-Based Stress Reduction programs which are offered all over the US, are generally quite cheap and often sliding-scale... and the really determined can put together a program for themselves using information freely available online.

There's no inherent costs associated with changing the way you think, as for the time, well.... how much time do people spend spinning their wheels in distress? I think if someone is so busy with their day to day life that they can't take 20-30 mins a day out to try to improve their quality of life, probably they're not suffering that much to begin with?

 

I support funding research for a cure for tinnitus, but see nothing wrong with using CBT in the meantime, to cope with the stress that tinnitus can bring, get our lives back, and speed up habituation as best as currently possible. In time, more psychologists will be better equipped to handle tinnitus patients, which there is currently a need for, especially in locations other than major cities.

 

They won’t be well equipped if they base their CBT treatments on ideas that don’t represent the whole tinnitus spectrum, such as tinnitus always gets better, it won’t get worse or everyone can learn to tune it out.

The way CBT and mindfulness are being promoted affects how the need for medical treatments for tinnitus is viewed. Too many so called tinnitus experts make it clear that they don’t understand why we need medical treatments to begin with. There are many doctors and therapists that have either directly said or implied that tinnitus in itself can’t be debilitating. On top of that they recommend people not to care about research, thus even less people speak up.

 

CBT, as it exists today, is not for people who are incapable of habituation.

No CBT practitioner who is familiar with tinnitus, either through personal experience or through training, would deny that tinnitus is debilitating. Dr. Hubbard's personal story, which is in a thread on this site, goes into detail regarding how it affected him.

It is not the job of psychologists to be cheerleaders at every opportunity, for medical cures for their patients, whether they have cancer, organ damage, alcoholism, blindness, tinnitus or anything else.

Throwing the baby out with the bathwater, i.e. rejecting CBT as it exists today, because it can't be of help with every case, or for some of those with other problems that prevent habituation, is the wrong approach and I think that most everybody would agree with that.

 

@Autumnly

I agree with you that these "so called tinnitus experts" are nothing of the sort. For instance, some people believe ENT doctors to be "tinnitus experts" but nothing more could be further from the truth. They are physicians that treat the Ear, nose and throat. Any underlying medical problem within the auditory system causing the tinnitus they will usually try to treat it, medically or surgically. This does not make them an expert in tinnitus. Most (but not all) have never experienced the condition and hence, their lack of understanding about it. One only has to read the many posts in this forum where people say, their ENT doctors show no understanding or empathy towards the way they feel.

When there is no underlying medical problem causing the tinnitus, as in "noise induced" a patient should be referred to a Hearing Therapist or Audiologist who's trained in tinnitus and hyperacusis management. My personal opinion, unless these health professionals have tinnitus I don't regard them as "Tinnitus experts" This is particularly relevant when treatments such as TRT and CBT are practised as they incorporate counselling with a patient.

Michael

 

I agree that CBT shouldn’t be the end treatment for tinnitus because it doesn’t fix the problem, but is a bandaid. Having said that I would rather have a bandaid for a bleeding wound and wait for stitches (cure), than have no bandaid at all.

I understand certain people say CBT is all you need for tinnitus, and it isn’t. People who portraying CBT as a treatment for tinnitus and not specifically for the anxiety and depression that comes from it are hurting our cause. CBT was never meant to treat tinnitus, only the anxiety and depression surrounding it. We still need a cure for tinnitus.

CBT is another tool to help people cope, but isn’t fixing the problem at large. This is an issue of people being stupid and saying CBT treats tinnitus when it doesn’t. CBT treats the symptoms, not the problem.

I also acknowledge that CBT won’t work for everyone. I think everyone should try it, but I am aware that it doesn’t help some depending on their circumstances.

 

Hubbard himself clearly makes that case in the sense that he implies tinnitus can't be debilitating in itself. And yes there are others that are implying this as well, especially in Germany.

This is from a recent ATA podcast episode:

JC: I know Dean and I agree, as well as many other professionals with whom we've spoken, that people who have troublesome tinnitus have a significantly larger incidence‐‐ possibly most of them have some kind of a psychological basis for that problem. I believe that people with bothersome versus non‐bothersome tinnitus have a psychological basis for the difference in the tinnitus effects between them. Do you agree with that?

Hubbard: Yeah, that's true, and that's been demonstrated in numerous research projects. There are differences in how they think about tinnitus, how they pay attention to tinnitus, and how they behave around their tinnitus. So, their thought process becomes very negative. We call it catastrophic thinking, really jumping to the worst‐case scenario.

 

Holy shit I can’t believe the ATA is saying shit like this.

 

And there are many more statements like this that you can find either on their homepage or that were said by people of the ATA or by people they invited to their podcast series. It usually boils down to the same idea: people who struggle react negatively to their tinnitus (which is why they struggle) and that's why CBT is so effective.

 

I find it interesting that people who don’t have tinnitus or have a mild version of it love to talk about how it’s not that bad. They also like to talk about how their personal experience is universal. How stupid.

I equate this to politics where a group of only men are making legislation regarding women’s health issues. Doesn’t make much sense...

 

I feel a bandaid for a severed artery is pointless. CBT very well might be my doom for this is the only thing afforded to me when I should be medicated with drugs that may give me some quality of life.

 

I agree with pretty much all you say on CBT. A major problem is that for most of our tinnitus organisations CBT is seen as a sufficient and satisfactory treatment for tinnitus. Again and again tinnitus charities will spend yet more money on CBT research when what we actually need is good quality biomedical research.

I don't doubt that CBT might help some tinnitus sufferers slightly. But that's about it. My own experience of CBT for tinnitus several years ago was from a therapist who didn't have tinnitus herself and therefore had little real empathy for the condition. Several of the things she told me then about noise exposure were completely wrong. Nearly eight years tinnitus has taught me that the best possible path to habituation is to limit loud noise exposure as much as is humanly possible. The more lengthy spikes from loud noise exposure, the longer the time it will take to habituate.

 

It’s an analogy not supposed to be taken literally.

Why can’t you go on medication?

 

My ex GP is worried about addiction and favours CBT.

 

It's a tool best suited for mild tinnitus sufferers.

 

Actually, it is suited for all kinds of sufferers because tinnitus sufferers of all kinds of severities are prone to irrational thinking.

The only thing to keep in mind is that it is not meant to help you with your tinnitus symptoms. It's important to have the right expectation. Instead, it is meant to address your irrational thoughts, irrespective of your tinnitus symptoms.

 

Yes, this is it, exactly.

 

I agree with you, @fishbone.

 

“Hubbard is a total idiot...!!!”

But a great ‘get out’ clause for him.
If his extortionate ineffective therapy fails to work for you he can always blame it on the nervous breakdown you never had !!

 

In general, tools like CBT and some sort of positive reinforcement can really go a long way and affect our mental health in such a positive way. I use to have horrible OCDs and it was quite a struggle daily. This was not even based on tinnitus either, I had issues that would freeze me up at times and stop me in my tracks.

I just got tired of dealing with it daily and having that negativity freeze me and hold me back. I was not going to be held back anymore, I slowly talked myself into dealing with my OCDs and told myself "You can do this, you will be ok", "take it slow, take baby steps, it's one day at a time". I controlled my breathing and just felt motivated to make something good happen.

It took awhile, but I overcame some pretty nasty OCDs that were very brutal and I'm glad that I stood up to my OCDs and used positive thinking/reinforcements. I was the only one that could help me. Pretty much WE are the only ones that can ourselves.

 

Total agreement Fish.
We have to become our own ‘T’ guru.

I most certainly would never trust a therapist who believed, as Hubbard does, that:
“Tinnitus can not be debilitating in itself - there must be some other underlying psychological cause.”

It truly makes me wonder however he would cope, if he were to actually get ‘Tinnitus?”

 

I will never take anyone's comments on life matters, as a serious one unless....they walk in my shoes on a daily basis. Unless they feel the pain I carry on a daily basis!

 

I think all this stuff is subjective, if it doesn't work for you but it works for someone else...whose life might be saved by it...then it matters and should be considered as an alternative method of healing. I never knew what habituation was but when someone here kindly mentioned it to me it was an invaluable piece of advice, it gave me hope, and hope is important.

Now that does not mean that one thing that worked for me will work for everybody!! If T is different for everyone, so then is the treatment/method of coping. People need to be open minded to alternative ideas, both the professional community as well as the tinnitus sufferers.