Cognitive Behavioral Therapy

[ChrisBoyMonkey]

@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.

 

[JohnAdams]

CBT in a nutshell:
Does tinnitus stress you out? Then just don't.

 

[Seth4kHz]

@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.

 

[JohnAdams]

@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.

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?

 

[ChrisBoyMonkey]

@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.

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.

 

[JohnAdams]

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

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.


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.

 

[JohnAdams]

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.

 

[JohnAdams]

@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.

From that paper you cited:

Do not recommend dietary supplements....

Hey all so I have been taking Turmeric capsules with curcumin for 2 weeks now and have noticed a lowering of tinnitus, I stopped taking them for 2 days and noticed a spike so began taking them again and it seems to not be a placebo, will keep everyone posted.

Even if curcumin doesn't help my tinnitus and hyperacusis (I'm not sure - tinnitus does seem a little softer and I have better moments with hyperacusis) I'm still going to keep taking this stuff. Curcumin is the shit when it comes to health benefits! Who knows, it could probably also decrease the risk of further ear damage.

On another note: My anxiety has been drastically lower these last 3 days. I can't fully attribute that to the curcumin......at least not yet......I have had good periods in terms of anxiety before......but the anxiety has been really shitty lately, for a long time, and only just now has it gotten better. Could be a coincidence BUT curcumin is said to be able to lower anxiety in some people, sooo.......maybe.

Curcumin has, imo, had a positive effect on my T. If your T profile is similar to mine, you *may* also get a benefit from it.

I've noticed the exact same thing! I've had daily anxiety for years and it's noticeably been less since I started the curcumin. Like you, I can't be sure yet, but it's an interesting theory for sure.

I had been taking Bioglan Curcumin double strength 1200mg but I started bruising easily, I have since cut back to 600mg and also started taking Bioglan 1000mg Vitamin C daily. I have only been doing this combination for ten days but I do feel it is helping...

Ok so I'm back with a new experience. Tried it again today after a meal with no water. Took 1 tablet (600mg) and now my tinnitus is extremely quiet, like barely a whisper even when plugging my ears. This level of quiet has happened before on good days, but it was quite loud this morning and has appeared to go right down after taking the tablet.
It could be a coincidence but I might keep experimenting with curcumin.

 

[Bartoli]

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.

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

 

[ChrisBoyMonkey]

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

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.

 

[jay777]

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?

x=weeks =$$$$$

 

[Bartoli]

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.

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.

 

[GregCA]

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.

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.

 

[ChrisBoyMonkey]

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.

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.

 

[linearb]

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.

 

[JohnAdams]

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.

 

[Juan]

CBT cannot fix T or H. It is just a waste of money.

 

[DaveFromChicago]

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."

 

[JohnAdams]

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."

I'd say it's more like a therapist telling you how to be happy with your electricity being out.

 

[TheDanishGirl]

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.

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.

 

[DaveFromChicago]

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.

 

[linearb]

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.

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.

 

[JohnAdams]

acceptance of this sound as "benign" as the final one.

How can this be benign? These are just evil rat psychologists that are leeching onto this disease to expand their market for patients.

 

[JohnAdams]

The basis of CBT is acceptance. Sure, let's just accept not being able to concentrate, not being able to sleep.

They are setting a paradigm that being bothered by tinnitus is our fault for not accepting it. Like it is a form of maladjustment.

Martin Luther King Jr. had something to say about the psychological concept of maladjustment.


Look, as long as I am on this forum, I am going to wreck any and all assholes that come here peddling this nonsense. We cannot have a bunch of quack psychologists running around claiming that the distress that tinnitus causes is somehow overcomable by accepting it. The logical outcome is that it is our fault if it bothers us. That's not just wrong, but it is evil.

This quackery is pushed by the BTA:
https://www.tinnitus.org.uk/tinnitus-and-cognitive-behavioural-therapy-cbt

Thank you @David for helping promote the idea that tinnitus distress is our fault.

God help us.

 

[Seth4kHz]

Is the basis of CBT acceptance, or is it providing coping strategies for people who have no other relief, or want to supplement other strategies they are pursuing? There certainly is decades of evidence for a psychological basis for relief. It doesn't necessarily follow the problem exists only in the patient's head, nor does it imply the problem is the patient's fault. I do see the point about how a narrow focus on CBT could detract from progress towards real solutions. But let's be honest: to date there is no cure for T that is broadly and consistently successful (or if there is, please point me to that thread). In the meantime can't we be adults and be open to T management on multiple fronts?

 

[JohnAdams]

nor does it imply the problem is the patient's faul

Logic is as follows:
CBT is effective.
If you're stressed from tinnitus, and you haven't done CBT, then you are ignoring an effective treatment, which means it is your fault that you haven't sought treatment.

 

[Seth4kHz]

Logic is as follows:
CBT is effective.
If you're stressed from tinnitus, and you haven't done CBT, then you are ignoring an effective treatment, which means it is your fault that you haven't sought treatment.

Okay JohnAdams, I appreciate your viewpoint but I respectfully disagree, and I'm going to bow out of the CBT sparring match.

You obviously have a vendetta against CBT. Kudos for getting your message out there and sticking to your guns.

As for me, I'm going to be open-minded about any treatment that offers relief from distress, especially when backed by evidence-based science. I'm still interested in addressing the root cause, looking for a cure. It doesn't seem like we need additional research on CBT because it's already been vetted in peer-reviewed studies. Patients can pursue the CBT if they choose, and according to the statistics many will get relief. Peace.

 

[FGG]

The basis of CBT is acceptance. Sure, let's just accept not being able to concentrate, not being able to sleep.

They are setting a paradigm that being bothered by tinnitus is our fault for not accepting it. Like it is a form of maladjustment.

Martin Luther King Jr. had something to say about the psychological concept of maladjustment.


Look, as long as I am on this forum, I am going to wreck any and all assholes that come here peddling this nonsense. We cannot have a bunch of quack psychologists running around claiming that the distress that tinnitus causes is somehow overcomable by accepting it. The logical outcome is that it is our fault if it bothers us. That's not just wrong, but it is evil.

This quackery is pushed by the BTA:
https://www.tinnitus.org.uk/tinnitus-and-cognitive-behavioural-therapy-cbt

Thank you @David for helping promote the idea that tinnitus distress is our fault.

God help us.

Seriously.

I agree with everything you said and this is coming from someone who earnestly tried 5 or 6 months of CBT, mediation and "reframing" exercises.

I honestly think the "radical acceptance" idea is promoted way more by non-sufferers (or mild sufferers) than sufferers.

My ex husband even used this idea to justify leaving me after my hearing damage because clearly it was my fault that I didn't "want to get better" and "focus on the positive" and just wanted to "wallow in self pity." The internet is apparently full of people who just CBT'd their way out of all kinds of suffering and he would point to that and say that I must just be mentally ill and even narcissistic to be thinking of my own suffering so much. He would have handled it "so much better" apparently.

In actuality, he left because emotional support requires sobriety (which is a whole other issue) but the fact that a few of our mutual friends saw this as a completely valid excuse for leaving your distressed wife completely alone shows you how far "toxic positivity" has come. It feels like victim blaming. We don't need a "new normal." We need to be able to hear quiet, speech and music normally again. We need a cure.

I am all for trying to make the best of things but it seems like no matter what affliction you have, people are now blamed for not using psychology or positivity the right way or for just "rising above it" like the person they saw on Ellen did or whatever. All without acknowledging that some people really do have it much worse.

God help us indeed.

 

[JohnAdams]

I agree with everything you said and this is coming from someone who earnestly tried 5 or 6 months of CBT, mediation and "reframing" exercises.

I mean, it's painfully obvious.

 

[Harley]

The basis of CBT is acceptance. Sure, let's just accept not being able to concentrate, not being able to sleep.

They are setting a paradigm that being bothered by tinnitus is our fault for not accepting it. Like it is a form of maladjustment.

Martin Luther King Jr. had something to say about the psychological concept of maladjustment.


Look, as long as I am on this forum, I am going to wreck any and all assholes that come here peddling this nonsense. We cannot have a bunch of quack psychologists running around claiming that the distress that tinnitus causes is somehow overcomable by accepting it. The logical outcome is that it is our fault if it bothers us. That's not just wrong, but it is evil.

This quackery is pushed by the BTA:
https://www.tinnitus.org.uk/tinnitus-and-cognitive-behavioural-therapy-cbt

Thank you @David for helping promote the idea that tinnitus distress is our fault.

God help us.

They want us to accept the unacceptable, so they can wash their hands of spending money on a real treatment.

Personally, I find the whole notion behind CBT insulting to my intelligence.
My tinnitus volume is not going to lower, just because some person sitting across the table feeds me some feel good, scripted BS, while charging me couple hundred dollars per session.
I know what I have and I'm never accepting this (or submitting to it, or calling it my friend... etc)
That is just insulting.
Period.

But as long as we have people from our own ranks preaching about the virtues of these quack solutions, our plight for a real treatment will not be taken seriously.
We need to think outside the box and we need to think about what kind of messages we are sending to the outside world.

It does seem, that the tinnitus community is very slowly starting to wake up and the tone is starting to change towards demanding real treatment options, but this awakening should have happened some 30 ****** years ago!!

If that were the case, I'm 100% convinced, that we would have the cure by now.
Sadly quacks like Jastreboff and the gang managed to convince lot of people, that all they really need is a bit of an attitude adjustment.

We are not lesser people or second class citizens.
Most of us have been paying into the health care system for bigger part of our lives without a complaint.
But we now need that the system gives us something in return.

And finally a message to those of you who are preaching that everyone can habituate to their tinnitus:
Look... Your intentions might be good, but do us a big favour.

Would you kindly just shut your mouths already and stop throwing the rest of us real sufferers under the bus with your lies and misinformation?
Thank you so much.