Cognitive Behavioral Therapy

Discussion in 'Treatments' started by Sven, Jun 17, 2013.

    1. Dr. Hubbard

      Dr. Hubbard Member Clinician

      Location:
      New York City
      Tinnitus Since:
      1991
      Cause of Tinnitus:
      Loud Music
      Hey All,

      I’d like to take some space here to describe contemporary CBT for tinnitus, as there are some misunderstandings expressed in this strand. (I apologize in advance for the length of this post!)

      First, CBT has evolved greatly over the past ten years. It’s no longer accurate to describe CBT as “recognizing and correcting maladaptive ways of thinking.” Such an over-simplistic approach could never address the depth and complexity of tinnitus distress. Contemporary CBT does involve cognitive tools, but uses additional strategies that address the problem more fully. These strategies are drawn from newer forms of CBT, including Acceptance & Commitment Therapy (ACT) and Mindfulness-Based Cognitive Therapy (MBCT), both of which have been shown to be effective in treating tinnitus distress.

      So the goal of CBT is not just to change your thinking, but rather to change your inner relationship with the sounds and sensations of tinnitus, and, as the end-point in treatment, to take the courageous action necessary to fully rejoin your life. A good cognitive-behavior therapist will teach you the cognitive, acceptance, and mindfulness skills, and then coach you in using these skills to resume your former lifestyle.

      As an added bonus, most cognitive-behavioral therapists are qualified to treat the emotional conditions often associated with tinnitus, including anxiety, depression and insomnia. So for these tinnitus sufferers, CBT may constitute one-stop-shopping!

      Here are some specific strategies used in contemporary CBT for tinnitus:

      Cognitive Restructuring: Learn to think in a more realistically and effective manner about tinnitus, learn the facts, and practice coaching yourself in an encouraging manner.

      Acceptance: not fighting and bracing against tinnitus (the natural response), but allowing tinnitus to be present as a new strand in your soundscape. This may be very hard to do, but it is NOT impossible, and gets easier with practice.

      Mindfulness: A common component of contemporary CBT, used to soften your reaction to tinnitus and make it easier to take effective action to resume your life.

      Values-Directed action: Courageously resuming the activities you’ve abandoned due to tinnitus.

      Hope that helps! I welcome any responses.

      Sincerely,

      Dr Hubbard
       
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    2. jazz
      No Mood

      jazz Member Benefactor

      Location:
      US
      Tinnitus Since:
      8/2012
      Cause of Tinnitus:
      eardrum rupture from virus; barotrauma from ETD
      @Dr. Hubbard

      Thanks for the explanation and clarification on CBT.

      I've read enough studies about tinnitus annoyance and psychological therapies to know that treatments like CBT can and do help many tinnitus sufferers.

      But I believe many people just don't understand how or why therapies like CBT work. For some people, the thinking may be as follows:

      Tinnitus has ruined my life; it's a terrible sound; how can I be happy with or forget about this awful sound?​

      I believe this thinking is behind the negative responses on a recent post about a trial on the Ecological Momentary Assessment of Tinnitus.
      Could you explain how tinnitus annoyance serves to magnify tinnitus perception? I believe people don't understand the limbic component to tinnitus.

      Everyone, myself included, wants a cure for tinnitus--a pill or some type of zapping device to make it go away. But until this happens, it only makes sense to make peace with your tinnitus. Until you do, it will never fade in the background. And I say this while still struggling with my own tinnitus.
       
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    3. Dr. Hubbard

      Dr. Hubbard Member Clinician

      Location:
      New York City
      Tinnitus Since:
      1991
      Cause of Tinnitus:
      Loud Music
      Great point Jazz! In the absence of a cure, habituation - not thinking or caring about tinnitus - is the next best thing. So why doesn’t habituation occur naturally for a significant portion of tinnitus sufferers?

      Our brains have an emergency responses system triggered in the brain's limbic system. When the brain judges something as a threat, it goes on alert, constantly monitoring the threat for signs of change. This "hypervigilance" is the heart of tinnitus annoyance. And hypervigilance blocks habituation. So hanging on to your annoyance of tinnitus not only deepens your distress, it prevents adjustment and resumption of a healthy lifestyle. Softening your reaction to tinnitus relaxes hypervigilance, paving the way for habituation.

      There's no question that tinnitus can be genuinely upsetting, scary, and annoying. Choosing to accept tinnitus, or any chronic hardship, is a trying and noble endeavor, but one that can pave the way for habituation, and establish the serenity to live life to the fullest, even with tinnitus. This takes patience, and repeatedly reminding yourself of the importance of your goal. Anyone interested can see my own success story for a description of the CBT process:

      https://www.tinnitustalk.com/threads/how-cbt-helped-me-live-again-dr-hubbards-story.4608/

      Best wishes!
      Dr Hubbard
       
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    4. Lisa88

      Lisa88 Member

      Tinnitus Since:
      11/2013
      Thank you Dr. Hubbard for this thread.
      Seems like CBT is one of the big keys to speeding up habituation.

      Just wondered if anyone familiar with CBT can give some examples of substituting negative thoughts on t for positive ones.

      Maybe one example could be when we wake up in the morning to loud t.
      Instead of saying: Grrr. What an awful way to start my day. It's there again, and will never go away.
      Say: If I get up soon and start distracting myself, I will notice this less, and all will be OK on the road to habituation.

      Or something like that :)

      Any comments/suggestions/thoughts?

      I understand part of the therapy involves first labeling your negative thoughts. Then substituting the affirmations.
      I take a quote from Dr. Nagler's toolbox website, as follows:

      In their (now out-of-print) book Tinnitus: A Self-Management Guide for the Ringing in Your Ears authors Jane Henry and Peter Wilson gave examples of twelve cognitive distortions commonly experienced by people who truly suffer from severe intrusive tinnitus. You might recognize some that apply in your own case. (And I suspect that you can come up with plenty of your own.) Here is the list that appears in the book, copied with Professor Wilson’s kind permission:


      ·An example of overgeneralization:

      Because of my tinnitus I was awake all night. Every night will be the same.


      ·An example of all-or-nothing thinking:

      Before I had tinnitus my life was perfect. Now my life is ruined.


      ·An example of filtering:

      My tinnitus is much worse after the party. I enjoyed the company but my tinnitus spoiled everything.


      ·An example of mind-reading or jumping to conclusions:

      When I have to ask people to repeat things because I don't hear well, I know they think I'm an idiot.


      ·An example of magnification or catastrophizing:

      My tinnitus is louder – I know I'll become deaf.


      ·An example of minimization:

      So what if I managed my tinnitus today? I know that is a fluke.


      ·An example of personalization:

      I was so annoyed by my tinnitus that I ruined the night for everyone.


      ·An example of jumping to conclusions:

      The tests say that my hearing is OK, but I know I'm going deaf.


      ·An example of emotional reasoning:

      My tinnitus makes me feel so hopeless. I know there is no hope.


      ·An example of "should" statements:

      Having tinnitus should never upset me.


      ·An example of labeling:

      Having tinnitus and hearing loss means that I am totally disabled.


      ·An example of blaming:

      I wouldn't be so annoyed with my tinnitus if my family understood.
       
    5. Scott T
      Alone

      Scott T Member

      Tinnitus Since:
      2008
      Cause of Tinnitus:
      Ear wax removal?
      Has anyone tried CBT?

      I went to a group session last night and it was focused on meditation and breathing. Very "introduce yourself, why are you here, what do you want to get out of these sessions"

      Not sure that it is right for me as I am very analytical and a no BS or fluff person.

      My tinnitus has spiked 5 weeks ago due to microsuction and not sure if this sort of therapy can help me. Thoughts?
       
    6. Tom Cnyc

      Tom Cnyc Member

      Location:
      NYC
      Tinnitus Since:
      05/2016
      Cause of Tinnitus:
      Warehouse event after years of enjoying music.
      CBT has not helped my tinnitus at all. If you expect it to - it won't. It's somewhat helped my reaction to it, but not enough for me to feel it's a success.

      That said, I do feel it's helped other areas of my life, and wish I had the wherewithal to realize a shrink would have helped me when I was still "healthy".
       
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    7. SeekIngAlpha

      SeekIngAlpha Member

      Tinnitus Since:
      2003
      Cognitive behavior therapy working for anyone and if yes how?
       
    8. squeek

      squeek Member

      Location:
      Australia
      Tinnitus Since:
      2009
      Cause of Tinnitus:
      Noise impact/maybe seaborn
      I've reduced my hyperacusis by 70% with CBT but it's done nothing for the tinnitus. It's only going to act on the psychological portion of the condition.
       
    9. valeri

      valeri Member Benefactor Hall of Fame

      Location:
      Australia
      Tinnitus Since:
      09/2011
      How did CBT work on hyperacousis?
       
    10. Marie79

      Marie79 Member

      Location:
      USA
      Tinnitus Since:
      2/1/16
      Cause of Tinnitus:
      Ear infection
      I would like to hear as well on how CBT works for hyperacusis
       
    11. squeek

      squeek Member

      Location:
      Australia
      Tinnitus Since:
      2009
      Cause of Tinnitus:
      Noise impact/maybe seaborn
      CBT is going to get you to face your fears a little bit at a time. In my case when I first started I would take out my ear plugs and walk two metres into the shopping centre and walk out again. The next week I would walk 4 metres. I challenged myself to increase my exposure a little bit at a time.

      After a while you will get to really know which sounds aggravate the tinnitus and which are psychologically influenced.

      I still can't handle kitchens and restaurants. I can still hear whispers even with earplugs. But the psychologically influenced hyperacusis is pretty much removed.
       
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    12. Marie79

      Marie79 Member

      Location:
      USA
      Tinnitus Since:
      2/1/16
      Cause of Tinnitus:
      Ear infection
      I really wish I could find a CBT person that specialized in this. Or did you just go to any CBT person?
       
    13. whitelight
      Sad

      whitelight Member

      Tinnitus Since:
      03/2015
      Sir, I've sent you a private message on another topic. If you could be so kind to reply, I would be very grateful.
       
    14. squeek

      squeek Member

      Location:
      Australia
      Tinnitus Since:
      2009
      Cause of Tinnitus:
      Noise impact/maybe seaborn
      I just went to a psychologist that my GP recommended. I get the impression that most psychologists are skilled in CBT.
       
    15. whitelight
      Sad

      whitelight Member

      Tinnitus Since:
      03/2015
      Hello -- sorry, the last note of mine is for Dr. Hubbard. Thank you!
       
    16. Candy

      Candy Member Benefactor Advocate

      Tinnitus Since:
      06/2016
      Cause of Tinnitus:
      Unidentified
      @Marie79 been doing CBT from the first week since onset again, would strongly advise to try some...already put into practice CBT for many years, which helped me in life. In this instance they aren't telling me anything new, however for those new to CBT definitely worth giving it a go. Here in the UK it would have to be a clinical psychologist who practices CBT, u may want to ask them if the've had Tinnitus patients.
       
    17. Mahr
      Doh

      Mahr Member Benefactor

      Location:
      The Netherlands
      Tinnitus Since:
      2011
      Cause of Tinnitus:
      unknown, probably hair cell damage
      Starting CBT next wednesday! Since there is no cure yet I do have to make a change in my way of thinking. CBT might help I guess..
       
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    18. MikeP505
      Curious

      MikeP505 Member Benefactor

      Location:
      Ontario Canada
      Tinnitus Since:
      2011
      Cause of Tinnitus:
      Punishment for being so darn good looking!
      Wishing you success. Keep us posted.
       
    19. MikeP505
      Curious

      MikeP505 Member Benefactor

      Location:
      Ontario Canada
      Tinnitus Since:
      2011
      Cause of Tinnitus:
      Punishment for being so darn good looking!
      Couple quick questions.

      A patient walks into your office who is completely deaf in both ears other than "residual" hearing in one ear, and suffers from very loud high pitch tinnitus in both ears, would you still suggest CBT?

      If so, how would you implement this treatment?
       
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    20. Mahr
      Doh

      Mahr Member Benefactor

      Location:
      The Netherlands
      Tinnitus Since:
      2011
      Cause of Tinnitus:
      unknown, probably hair cell damage
      Just had two CBT sessions. In the first session the psychologist explained what happens if you develop a tinnitus syndrom; random complaints with the T centered in it. Complaints like fatigue, problemsleeping, intestinal problems etc. After this session I had to fill in a questionaire; all kind of questions about what might have triggered the T.
      The last session we did an inventory of the answers I gave. We, at this point, are busy trying to figure out what caused the T, what triggers it to get worse. All this would help me understand better what I can do myself; my behaviour, my way of thinking. For now, I feel listened to, heard and understood.
      (sorry for the grammar..)
       
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    21. Tom Cnyc

      Tom Cnyc Member

      Location:
      NYC
      Tinnitus Since:
      05/2016
      Cause of Tinnitus:
      Warehouse event after years of enjoying music.
      CBT won't cure tinnitus but I'd say it definitely helped me through the darkest months of my life.
       
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    22. Bobby
      Bitchy

      Bobby Member

      Tinnitus Since:
      November 2013
      I have read all this, and still don't understand what CBT is beyond "forceful positive thinking" - which has done absolutely NOTHING for me except excacerbate cognitive dissonance.

      I really want to reduce my anxiety reaction to tinnitus. I would really like to think that this "CBT" can help me, but I STILL DO NOT KNOW WHAT THE ____ IT EVEN IS, AND "PROFESSIONALS" CANNOT EXPLAIN IT TO ME EITHER.
       
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    23. Paul10

      Paul10 Member

      Tinnitus Since:
      12/2016
      Cause of Tinnitus:
      Stress
      Just because T has no universal "cure" doesn't mean it can't be treated. There are various treatment options available depending on the reason for your T. T brought on by depression/anxiety can often be treated with medication and professional guidance, including CBT. I say this all the time - seeking professional help and guidance is the most important thing about T; it is so unique, the internet is filled with muddled-up information which may or may not relate to you specific T. An audiologist/hearing therapist specialising in T is the best point of contact to get the ball rolling and building a network of professionals.
       
    24. Frédéric

      Frédéric Member Benefactor

      Location:
      Marseille, France
      Tinnitus Since:
      11/19/2012
      Cause of Tinnitus:
      acoustic trauma
      Just in order to feed this thread : I followed about 15 sessions (45 min. each) during 2013-2014 of CBT with a CBT psychiatrist specialized in tinnitus. Unfortunately , no change in my mindset in relation to tinnitus.
       
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    25. Jomo

      Jomo Member

      Tinnitus Since:
      9/4/16
      Cause of Tinnitus:
      going for a rim shot on the snare drum.
      Hi Dr. Hubbard

      I dont mean to highjack the topic but i have a friend who has been struggling with anxiety for a few years. The anxiety can get so bad that his hand begins to shake and affects his ability to perform at work. The trigger appears to be dealing with people. This condition has lead to him taking clozapam to help deal with these symptoms. Would CBT be an effective way at helping someone overcome a condition like this without drugs? Do you put a person in situations and force them to become comfortable? I know he received some type of therapy but it did not help at all and usually was just him voicing what bothers him and talking about how his day went. They told him to try meditating but it was no help. Your response would be very helpful. Luckily for myself I have been able to deal with my T and regain most of the life I used to live. Thanks for the insight into CBT.
       
    26. Kaelon
      Wishful

      Kaelon Member Benefactor

      Location:
      Boston, Mass.
      Tinnitus Since:
      11/2014
      Cause of Tinnitus:
      Muscle Spasms
      This a question for all of you who have gone through this, or for our clinicians (especially @Dr. Hubbard) who may have some insight here.

      Background: I am successfully habituated to Tinnitus. I engaged in a largely self-directed regimen of lifestyle changes, physical activity, and intentional mindfulness and in under a year, was able to largely ignore Tinnitus and return to a pre-Tinnitus life from a productivity standpoint. However, I still hear my Tinnitus every moment of every day. I just don't care; it doesn't bother me.

      Question: Is there any benefit to Cognitive Behavioral Therapy for people who are essentially like me, and already habituated? Or does it simply seek to advance habituation? Is there any literature or research on this topic?

      Thanks for your thoughts!
       
    27. ebbie

      ebbie Member

      Tinnitus Since:
      8/15
      Cause of Tinnitus:
      Meniere's
      CBT doesn't make tinnitus go away and if you're already habituated I see little point in it?

      CBT could help you in other life areas. Book an evaluation appointment with Dr Hubbard?
       
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    28. Kaelon
      Wishful

      Kaelon Member Benefactor

      Location:
      Boston, Mass.
      Tinnitus Since:
      11/2014
      Cause of Tinnitus:
      Muscle Spasms
      Thanks! Yes, I figured that I had essentially engaged in self-led CBT using a lot of the techniques described by the methodology. However, I wasn't sure if there were other added neurological benefits; it sounds like there might not be, and it's just designed to address the anxiety, which I've already dealt with. I appreciate the insight!
       
    29. Dr. Hubbard

      Dr. Hubbard Member Clinician

      Location:
      New York City
      Tinnitus Since:
      1991
      Cause of Tinnitus:
      Loud Music
      Hey All,

      Last March (2017) I gave an invited talk on Cognitive Behavioral Therapy for tinnitus which was recorded and is available on Youtube. This is a through explanation of the problem - how tinnitus becomes intrusive, even traumatic, for some people and not others - and how to address it with Mindfulness-Based Cognitive Behavioral Therapy. The talk is about 90 minutes long, so you may need to watch in over more than one sitting. For anyone who's interested, here is the link:

      Cognitive Behavior Therapy (CBT) for Tinnitus...
       
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    30. Dr. Hubbard

      Dr. Hubbard Member Clinician

      Location:
      New York City
      Tinnitus Since:
      1991
      Cause of Tinnitus:
      Loud Music
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