Cognitive Behavioral Therapy

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

    1. Lilah
      Supportive

      Lilah Member Benefactor

      Location:
      USA
      Tinnitus Since:
      12/2018
      Cause of Tinnitus:
      Unknown
      This past session, I made a list of all my anxieties (currently mostly tinnitus related), and my therapist and I developed counter responses to these anxieties. I thought it was helpful.

      I do feel that I am running the session and taking the lead. The therapist asked me questions along the way and helped me develop my responses but in the end I was the one who came up with the responses. Is this the way it's supposed to be?
       
    2. JohnAdams
      Festive

      JohnAdams Member Benefactor Hall of Fame

      Location:
      Vatican
      Tinnitus Since:
      May 1st 2018
      Cause of Tinnitus:
      Aspirin Toxicity/Possibly Noise
      Seems like that's the whole point, having a person there to guide you into taking control of your life and being there to affirm this with you.
       
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    3. Luman
      Spaced

      Luman Member Benefactor

      Location:
      Brooklyn
      Tinnitus Since:
      07/2017
      Cause of Tinnitus:
      Intermittent Tinnitus probably noise induced
      I believe that it is the goal of classic CBT, which is meant to be short term therapy that teaches you how to retrain your mind. Learning how to spot thinking patterns that cause problems, and knowing how to correct them with better, more rational thoughts, is a cornerstone of the foundation of this therapy.
       
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    4. Henry Orlando FL
      Balanced

      Henry Orlando FL Member Benefactor

      Location:
      Orlando, FL
      Tinnitus Since:
      10/2011
      Cause of Tinnitus:
      Loud sound via earbuds from a digital device.
      I am a member of the American Tinnitus Association. They just released a podcast with a psychologist, Dr. Bruce Hubbard, who has tinnitus and specializes in Cognitive Behavioral Therapy (CBT) for those with tinnitus. You can hear the podcast here:

      https://www.ata.org/podcasts/episode-10-habituation-tinnitus-using-cognitive-behavioral-therapy

      In this podcast, he tells you what you need to know about CBT. He also has a lot of free resources for those with tinnitus on his website here:

      https://www.cbtfortinnitus.com/cbt-for-tinnitus-resources

      He says many people can complete CBT for tinnitus in as little as 2 to 10 sessions with someone who is trained in CBT for tinnitus but unfortunately most therapists are not adequately trained in CBT and don't know anything about tinnitus. On his resource page, he has a 90-minute webinar, a mindfulness meditation audio, recommendations for self-help books (he is working on one of his own) and other key self-help information to give it a go for yourself. He does offer coaching on dealing with tinnitus as well should you need/want that.

      I suggest you give it a listen and look. Hope this helps.
       
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    5. Seth4kHz

      Seth4kHz Member

      Location:
      Portland, OR
      Tinnitus Since:
      11/2018
      Cause of Tinnitus:
      Hearing loss
      Hi all, I'm having an incredible fall Saturday morning including a walk to the farmer's market and baking a homemade apple pie. Incredible with the exception of my annoying and ever-present friend tinnitus, that is...

      I've heard CBT is one of the treatments with the most supporting evidence for tinnitus relief, so I'm interested in pursuing it. My audiologist & ENT even recommended CBT but didn't have any leads on a practitioner, even though I'm in a major metropolitan area (Portland, Oregon). So I have questions...

      1. What exactly is CBT?
      2. Did it work for you?
      3. How does one find a local practitioner specialized in tinnitus?
      4. Any advice navigating CBT with health insurance?

      Guidance on any or all of these is greatly appreciated!

      -Seth
       
      • Optimistic Optimistic x 1
    6. bellesisle

      bellesisle Member

      Tinnitus Since:
      07/2017
      Cause of Tinnitus:
      Medications
      Hi Seth, the apple pie sounds incredible. Surely understand the tinnitus issue. A prominent Cognitive Behavior Therapist (CBT) is Dr. Bruce Hubbard in New York. He works via FaceTime or by phone.

      His website is:
      https://www.cbtfortinnitus.com/dr-bruce-hubbard

      Scroll down to the end of that page and you will see his awesome success story as well as how to access his webinar which addresses tinnitus and CBT. His webinar is excellent. CBT is not about treating tinnitus, but “treating” your reaction to it. He is a musician with tinnitus and hyperacusis, as well as active in many educational and tinnitus organizations.

      Last time I checked, he can be found in the doctors corner tab of Tinnitus Talk. I worked with him and he helped me. He has lots of material that is helpful. He is very expensive though but his goal is to give you the tools so you can move forward. My insurance did not cover my sessions and he can explain the insurance issue.

      He also publishes in the American Tinnitus Association newsletter frequently. Hope this helps.
       
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    7. JohnAdams
      Festive

      JohnAdams Member Benefactor Hall of Fame

      Location:
      Vatican
      Tinnitus Since:
      May 1st 2018
      Cause of Tinnitus:
      Aspirin Toxicity/Possibly Noise
      It is a pseudo scientific therapy that works on the basis that your negative stressful mental reaction to having tinnitus is not based on the mere existence of your tinnitus, but rather on the way you react to its presence. It purports to be able to teach you mental strategies that enable you to think and react emotionally and cognitively in a more mindfully mature approach that will lessen your overall negative mental response to having this phantom sensation. It is the very definition of garbage.
       
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    8. ChrisBoyMonkey

      ChrisBoyMonkey Member Podcast Patron

      Location:
      US
      Tinnitus Since:
      2019
      Cause of Tinnitus:
      Noise
      @Seth4kHz

      If you're interested in something that might actually help reduce the tinnitus itself, check out the Lenire thread.

      It doesn't seem to have helped all of the users we have on here yet, nor do they guarantee it will, but it seems to be helping most at least to some extent, similar to the results the company in charge of it claim from their trial data.
       
      • Helpful Helpful x 1
    9. JohnAdams
      Festive

      JohnAdams Member Benefactor Hall of Fame

      Location:
      Vatican
      Tinnitus Since:
      May 1st 2018
      Cause of Tinnitus:
      Aspirin Toxicity/Possibly Noise
      CBT in a nutshell:
      Does tinnitus stress you out? Then just don't.
       
      • Agree Agree x 2
    10. Seth4kHz

      Seth4kHz Member

      Location:
      Portland, OR
      Tinnitus Since:
      11/2018
      Cause of Tinnitus:
      Hearing loss
      @JohnAdams I think I understand your frustration with CBT... it's not addressing the root cause and basically telling patients, "Toughen up, buttercup." On the other hand it has strong evidential support for providing relief, and is highly recommended in clinical practice guidelines (e.g., https://journals.sagepub.com/doi/pdf/10.1177/0194599814545325). Given there is currently no cure for tinnitus, what is the harm in pursuing CBT? I'm not trying to be confrontational here... I'm new to the forum and understanding the nuances surrounding tinnitus, so trying to get to the bottom of this.
       
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    11. JohnAdams
      Festive

      JohnAdams Member Benefactor Hall of Fame

      Location:
      Vatican
      Tinnitus Since:
      May 1st 2018
      Cause of Tinnitus:
      Aspirin Toxicity/Possibly Noise
      What do you think is in a therapist's head that is so important that we need to pay them to transfer it to ours?
       
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    12. ChrisBoyMonkey

      ChrisBoyMonkey Member Podcast Patron

      Location:
      US
      Tinnitus Since:
      2019
      Cause of Tinnitus:
      Noise
      The thing about CBT is that it's just some other person telling you how to change your feelings, which is something ultimately up to you regardless of who is telling you how to do it. I think the way we look at is that it is something you shouldn't have to waste huge chunks of money on.
       
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    13. JohnAdams
      Festive

      JohnAdams Member Benefactor Hall of Fame

      Location:
      Vatican
      Tinnitus Since:
      May 1st 2018
      Cause of Tinnitus:
      Aspirin Toxicity/Possibly Noise
      Have you seen what CBT entails? It works on the assumption that your beliefs about what the activating event evokes leads to the consequence and the therapist helps you change your beliefs about the activating event. Tinnitus is a physical stressor, you cannot change your beliefs about it. If anything, after a while you might habituate. All of that evidence for efficacy about CBT is nonsense. Tinnitus is going to stress out your brain regardless of what your beliefs about it are. It is just a bunch of shrinks trying to be useful un areas where they are useless. Its garbage.
      ABC model of Cognitive Behavioral Therapy


      CBT: Next time tinnitus stresses you out, just tell yourself it doesn't.

      Also, the music in this video is the same as the LA Beast.
       
    14. JohnAdams
      Festive

      JohnAdams Member Benefactor Hall of Fame

      Location:
      Vatican
      Tinnitus Since:
      May 1st 2018
      Cause of Tinnitus:
      Aspirin Toxicity/Possibly Noise
      CBT is basically all about self deception. The tinnitus is going to stress you out physically, like any pain, and there are going to be natural consequences to your overall mental and physical health. But with CBT you can just lie to yourself like everything is OK, when it is not. I always think back to the poop lady. This nut has convinced herself that living in a house with thousands of bottles of her doo doo is okay. It is self deception.
      The Poop Lady - Hoarders
       
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    15. JohnAdams
      Festive

      JohnAdams Member Benefactor Hall of Fame

      Location:
      Vatican
      Tinnitus Since:
      May 1st 2018
      Cause of Tinnitus:
      Aspirin Toxicity/Possibly Noise
      From that paper you cited:
      upload_2019-10-27_16-34-49.png

      Do not recommend dietary supplements....

       
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    16. Bartoli

      Bartoli Member

      Tinnitus Since:
      2009,worsened 2019
      Cause of Tinnitus:
      Noise
      Spend (or waste) huge chunks of money on CBT is ultimately the choice of the individual. I notice that a lot of people feel that whoever pursues CBT channels their money into the wrong cause. But it's not like these people would alternatively spend that amount on research towards a potential cure (wouldn't it be great if they did?)

      All I'm trying to say is that some don't have the luxury of holding out for a cure much longer. I feel CBT could be a worthwhile pursuit, failing a treatment that works on the sound itself. On my better days, I honestly can't tell whether mine is quieter or not. It could very well be that it's the same. I actually suspect this is the case. Now imagine if you could reproduce these results consistently. Would be pretty good in my opinion.

      Regarding the statement it's just someone else making observations for you: I think an outsider's view can be helpful and put things back into perspective. When people are distressed because of their tinnitus, it's easy to lose some sense of perspective. Having someone to guide you to regain some balance can be helpful I think.

      That said, I haven't tried CBT, but I don't discard it as totally worthless either. Unless there's a cure tomorrow. In that case: screw CBT. Gotta roll with what's available now I guess ;)
       
    17. ChrisBoyMonkey

      ChrisBoyMonkey Member Podcast Patron

      Location:
      US
      Tinnitus Since:
      2019
      Cause of Tinnitus:
      Noise
      Well that's exactly the case, we're on the verge of real treatments with Lenire as the first thing to hit the market and these money hungry CBT therapists still want to charge so many hundreds of dollars for less than an hour of their time.

      Yes it's up to the individual. Given our circumstances that we have stuff that might actually reduce tinnitus for less of the cost, so instead of having someone tell you to get used to it (which can be done without paying anything), it makes more sense to try and make a Lenire appointment since it's taking then now. If you have the money for CBT, maybe, but still it's just so expensive and ultimately is done on your own, not by a therapist. I feel it's all information we know already. "The sound isn't going to hurt you". "Listen to it to get used to it". I don't have to pay a therapist to know that lol.
       
    18. jay777

      jay777 Member

      Tinnitus Since:
      10/2017
      Cause of Tinnitus:
      benzo/ headphones
      x=weeks =$$$$$
       
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    19. Bartoli

      Bartoli Member

      Tinnitus Since:
      2009,worsened 2019
      Cause of Tinnitus:
      Noise
      Hope you're right! The money is less of a thing where I live because many hospitals offer it as part of their treatment so it's partly covered for by social care. I find it disheartening to see that the hospitals aren't really at the forefront of research and still preaching habituation. We had rTMS here some 10 years ago and now they went back to TRT because of lack of evidence.
       
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    20. GregCA
      Jaded

      GregCA Member Benefactor Hall of Fame

      Tinnitus Since:
      03/2016
      Cause of Tinnitus:
      Otosclerosis
      That would certainly be good, but that is not what CBT will help you accomplish. CBT does good things, but you have the wrong expectation if you think it'll help you "reproduce these results consistently". That's not what CBT targets and/or how it works.
       
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    21. ChrisBoyMonkey

      ChrisBoyMonkey Member Podcast Patron

      Location:
      US
      Tinnitus Since:
      2019
      Cause of Tinnitus:
      Noise
      Where do you live? It sounds great for a tinnitus sufferer. Sure they should be looking more into the new things, but way better than where I am. If they offer it for free sure, why not?

      Where I live the doctors never even mentioned anything about the tinnitus itself directly when I would visit them and instead just try to offer something for the symptoms. It's like they barely even acknowledged that it was happening. Truly a horrible experience.
       
    22. linearb
      Psychedelic

      linearb Member Benefactor Hall of Fame

      Location:
      destroy all creatures. they cannot be regenerated.
      Tinnitus Since:
      1999
      Cause of Tinnitus:
      karma
      ITT people who have never actually put any effort into CBT or any other cognitive technique and don't understand them waxing intellectual, I guess?

      CBT doesn't inherantly have anything to do with tinnitus; these strategies are very much evidence based, and there's strong evidence from imaging studies of structural brain changes following ~6-8 weeks of various different kinds of cognitive practices.

      It's not going to cure your tinnitus any more than it's going to cure your CRPS or Lyme or other chronic shitty thing you might have. Changing your perspective can (and inherantly does) none the less alter your experience of life, for better or worse.

      I'm not of the opinion that this is something which needs more money spent to research, and I am also very skeptical of anyone charging money to learn these techniques, since I think you can learn all the basics off youtube. So, the question of whether you should hire someone probably boils down to "are you someone who benefits from paying a therapist" and I can't answer that for you, but... lots of people do....

      The question of "can you reduce your fear response, distress and discomfort caused by a constant unwanted stimulus using cognitive techniques" is a resounding yes, and, again, there's good imaging studies to support that. But, I realize it is much easier to sit around pissing on ideas than to actually put effort into trying things over the extended period of time required to see any changes. All the studies I know involve at least a 45 minute daily commitment for ~6 weeks, which can be daunting.

      There's no good evidence for any particular supplement, and the common ones have been studied pretty extensively; hence there is no moral way a doctor can suggest them except to say "well, some people subjectively think they feel better from a supplement, so you are free to experiment at the risk of your wallet". A buncha people on some forum thinking something works, does not actually mean it does. If it worked that way we wouldn't need RCTs and this would all be much easier and cheaper.

      @GregCA and @Luman seem to get it.
       
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    23. JohnAdams
      Festive

      JohnAdams Member Benefactor Hall of Fame

      Location:
      Vatican
      Tinnitus Since:
      May 1st 2018
      Cause of Tinnitus:
      Aspirin Toxicity/Possibly Noise
      The worst part about CBT is that it is not a treatment but gives organizations like the ATA etc an excuse to not fund curative research because they can just recommend CBT.
       
      • Agree Agree x 2
    24. Juan

      Juan Member

      Tinnitus Since:
      08/2014
      Cause of Tinnitus:
      Several causes
      CBT cannot fix T or H. It is just a waste of money.
       
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    25. DaveFromChicago

      DaveFromChicago Member Podcast Patron Benefactor

      Tinnitus Since:
      01/2014
      Cause of Tinnitus:
      Headcold/Flu
      To Juan and JohnAdams:
      As I mentioned previously, CBT is the equivalent of an electrician visiting your house and saying "There's nothing I can do about restoring your electricity, so why don't you just learn to read until it gets too dark to see."
       
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    26. JohnAdams
      Festive

      JohnAdams Member Benefactor Hall of Fame

      Location:
      Vatican
      Tinnitus Since:
      May 1st 2018
      Cause of Tinnitus:
      Aspirin Toxicity/Possibly Noise
      I'd say it's more like a therapist telling you how to be happy with your electricity being out.
       
    27. TheDanishGirl
      Sad

      TheDanishGirl Member Benefactor Hall of Fame

      Location:
      Denmark
      Tinnitus Since:
      05/2017 (H since 06/2017)
      Cause of Tinnitus:
      long term noise exposure (headphones), maybe some stress.
      Yes for some people, but not all. I HAVE received CBT therapy/training twice in my life and put in the work hoping I would achieve something, but.........nothing..........just nothing. I don't feel the least bit happier or less depressed and less worried/angsty about my situation after having used CBT. It's great if it can help some people (which it certainly does) but it is not the answer for everybody.
       
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    28. DaveFromChicago

      DaveFromChicago Member Podcast Patron Benefactor

      Tinnitus Since:
      01/2014
      Cause of Tinnitus:
      Headcold/Flu
      To John Adams:
      I had no idea that CBT practitoners would so ludicrously endorse habituation as a "first step" and then acceptance of this sound as "benign" as the final one.
      This only demonstrates the very sadly limited, hocus pocus nature of such talking psychotherapy.
      I would be infuriated if I were charged $140.00 per hour for advice that frankly trivializes and underestimates the debilitating extent of this condition.
      And as I also indicated previously, we all have had to already painstakingly construct our own individual Rationalizing/Counseling systems just to be able to walk out the door with this condition in the morning.
      There is nothing that a CBT counselor could advise most of us on that we have not already utilized or discarded.
       
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    29. linearb
      Psychedelic

      linearb Member Benefactor Hall of Fame

      Location:
      destroy all creatures. they cannot be regenerated.
      Tinnitus Since:
      1999
      Cause of Tinnitus:
      karma
      I am sorry to hear that. I'd say I am similar in that formal CBT techniques from therapists were much less useful, ultimately, than meditation, but I'm someone who benefits from therapy in general and has always had decent insurance, so my experiences were all fine.

      That out of the way, rereading this thread -- you haven't been sitting here mindlessly pissing on the mere idea of CBT maybe helping some people while also tossing out a bunch of unscientific nonsense and anecdotes. So, I don't disagree with anything you said, nor did I suggest that any one technique is going to cause experiential change for any one person. If we dig through all the imaging studies I mentioned and/or cited above -- beneficial structural brain changes are noted in a small majority to most individuals, depending on study. That is far from "all". This is also to be expected and fine and will be the case for any treatment including actual tinnitus targeted therapies (if UMich / bimodal stuff ends up being really successful for more than about 50% of us I will be really pleasantly surprised).

      The diversity of our problems and experiences, for me, underscores the need to be open-minded in our approach to management strategies.
       
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    30. JohnAdams
      Festive

      JohnAdams Member Benefactor Hall of Fame

      Location:
      Vatican
      Tinnitus Since:
      May 1st 2018
      Cause of Tinnitus:
      Aspirin Toxicity/Possibly Noise
      How can this be benign? These are just evil rat psychologists that are leeching onto this disease to expand their market for patients.
       
      • Agree Agree x 4

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