An estimated 25 million Americans suffer from tinnitus (approximately 15 to 20 percent of the population), which is the perception of hearing sound inside the ear, regardless of if there is any external sound. Tinnitus sounds include roaring, ringing or buzzing and may vary intensity.
Tinnitus causes a variety of mental, physical and emotional stressors. Though tinnitus itself is not a serious health condition, its side effects can become severe and cause secondary conditions, such as depression and anxiety.
Many patients are unable to focus on anything but their tinnitus because they do not have the emotional coping techniques to function as they did prior to tinnitus. These patients often suffer more depression, overall distress, and feel their condition to be worse than those who have developed adequate coping skills. Unfortunately, most tinnitus sufferers do not seek treatment, believing there is no way to improve their condition. Though tinnitus cannot be “cured” or reduced, cognitive-behavioral therapy (CBT) has proven to offer much needed relief. CBT helps patients learn to control their emotional responses and remove their focus on tinnitus from their negative thought patterns and behaviors.
What is Cognitive-Behavioral Therapy (CBT)?
The goal of CBT is to improve the overall quality of life. Cognitive behavioral therapies provide patients with skills to reduce their attention to tinnitus while improving coping techniques and providing alternative thinking and behavior patterns aimed at distracting patients from their tinnitus. The overall plan for therapy is to increase pleasant activity, learn relaxation techniques, and add cognitive skills to replace negative (or unhelpful) thinking.
Behavioral therapies for tinnitus often require you to see a behavioral health specialist in addition to your hearing health professional or audiologist. CBT may also require coordinating care across multiple doctors, which sometimes can increase the complexity of treatment.
CBT for any condition involves multiple clinical sessions, which requires a commitment. Results are not instant, but cumulative. Successful treatment generally requires attending all therapy sessions. For tinnitus management with CBT, you must approach the treatment plan with an open mind and positivity because treatment relies so heavily on patient involvement.With the COVID-19 pandemic, seeking outside the home treatment for tinnitus may not be an option. Even without a pandemic, many patients do not have access to audiologists and therapists, especially rural and homebound patients. Thankfully, CBT for tinnitus is very effective via remote training, whether using a smart device, computer or the telephone. These telehealth or teleaudiology options for tinnitus allow patients to remain safe in their homes or at work.
How Does CBT Help with Tinnitus?
Behavioral therapies focus on your emotional reaction to tinnitus and not the “sound” itself. According to research, there is very little connection between the loudness or pitch of tinnitus and the amount of distress tinnitus causes a person. The condition becomes burdensome due to the psychological and cognitive reactions sufferers have in response to their tinnitus. In essence, your emotional response is the key in your perception of tinnitus – whether it does not affect you at all, it is a minor irritation or it has become the driver of distress, anxiety and depression.
CBTs are among the best established and most effective treatments for tinnitus. These approaches have consistently been shown to reduce tinnitus-related distress, anxiety, and depression, and to improve the overall quality of life for patients. Research has also show that these patient improvements after receiving CBT were found to be stable and long-term (up to 15 years).
Cognitive-Behavioral Therapies for Tinnitus
Mindfulness-Based Stress Reduction (MBSR) emphasizes “mindfulness” — an acute and non-judgemental awareness of one’s physical sensations, sensory perceptions, emotional reactions and cognitive processes. Rather than struggling to ignore tinnitus (an impossible task), MBSR teaches you to accept, embrace, and control your experience. In this way, you place yourself in a better position to manage your condition. MBSR may also be used to address the anger and apathy that tend to be attached to tinnitus.
Acceptance and Commitment Therapy (ACT) emphasizes the need to reduce trying to avoid tinnitus. You are taught to examine your thoughts, perceptions and emotions without judging them. When you accept even the most negative thoughts and feelings, you are able to find more control over your reactions.
Tinnitus Activities Treatment (TAT) focuses specifically on tinnitus management. TAT follows an step-based learning approach to look at four life areas that tinnitus affects:
- Thoughts and emotions
- Hearing and communication
- Sleep
- Concentration
The TAT process also often incorporates a low-level of supplemental sound therapy for masking purposes.
Tinnitus Retraining Therapy (TRT) combines the use of traditional CBT counseling with supplemental sound masking to habituate patients to tinnitus. The counseling component aims to demystify tinnitus and help the patient reclassify perceived ringing as an emotionally-neutral signal. Constant low-level broadband sound is further used to habituate the patient to the presence of tinnitus.Progressive Tinnitus Management (PTM) is a step-based approach that involves patient education, behavioral therapy and supplemental sound therapy. American Tinnitus Association members have access to a free digital version of the PTM workbook in the members section of ATA’s website.
How Do I Find a Telehealth/Teleaudiology Option?
Most states allow licensed audiologists to implement teleaudiology and a few states also allow hearing instrument specialists (HIS) to do so. If you already have an established patient relationship with an audiologist, call the clinic and ask about teleaudiology services for tinnitus. Explain your preference to use CBT therapy to manage your tinnitus. Your audiologist may also already have preferred CBT-trained therapists they can refer you to.
If you don’t already have an audiologist or established clinic, you can visit the American Tinnitus Association’s website. They have many resources for tinnitus therapy, including help finding a provider and podcasts with CBT therapies for tinnitus. Online forums are another option for you to meet with other tinnitus sufferers online and receive support along with recommendations.
If you are experiencing bothersome tinnitus, don’t suffer – contact us today to discuss a therapy option that will work for you. As tinnitus is often the first sign of hearing loss, this is a great time to get your hearing checked as well. Sonora offers many hearing aids with multiple options, including features to help with the symptoms of tinnitus.