Very well said, thank you. What I've been trying to say is that for patients, there is a plurality of approaches to management, relief from distress, alleviation of symptoms, and, potentially someday soon (we hope), a cure. It's called a holistic approach, and the people here bashing CBT don't get it. I want to defend JohnAdams for a moment though: he's on a mission to debunk what he sees as pseudoscientific babble, and I respect his enthusiasm and determination, if not his methods.
If you decide to go for it, all the best mate. There is a lot of information online and a good few books as well so maybe read them.
I had CBT for my OCD tendencies a while back and that helped me a lot if that's any consolation. I know this or any type of therapy doesn't work for everyone, that's the just the way it is. I have seen the good it can do, well therapy in general (I'm still on the fence in regards to what it can do for tinnitus) but if it helps great.
Therapy in general can be beneficial for people, sometimes we need that guide to give us that nudge in the right direction to get out of whatever dark place we are in as our emotional distress can stop us from thinking logically. It's not as simple as "what can a person tell us that we don't already know" unfortunately some people are that lost, alone and in so much pain that they actually don't have the answers for how they are feeling or how to get out of it.
As much as CBT is a load of bollocks, I now wish that 20 years ago i had gone down the CBT route only instead of the Prozac route combined with a little CBT to treat my OCD. If I had, I may not be on a tinnitus forum now.
Fast forward to today, I don't think CBT will do anything for me in my tinnitus situation, but it's basically all I've got. Bad tinnitus is a different animal to OCD, but the two combined equal up shit creek without a paddle.
After discussing this on the forum, I don't think I will go for CBT. I am a true believer the benefits of therapy (as if one needs to "believe" in science to make it real). But for now I seem to be coping well enough. The main things I'm pursuing are hearing aids (which indisputably help) and curcumin (which I started last night based on @JohnAdams prompt). I'll leave CBT open for the future though, if the T gets worse or if I lose the ability to cope. I don't think anyone should write off CBT completely--it has strong evidential support--but I'm taking a pass for now. Cheers, mate.
After discussing this on the forum, I don't think I will go for CBT. I am a true believer the benefits of therapy (as if one needs to "believe" in science to make it real). But for now I seem to be coping well enough. The main things I'm pursuing are hearing aids (which indisputably help) and curcumin (which I started last night based on @JohnAdams prompt). I'll leave CBT open for the future though, if the T gets worse or if I lose the ability to cope. I don't think anyone should write off CBT completely--it has strong evidential support--but I'm taking a pass for now. Cheers, mate.
That's great man, I hope you continue to move forward, I forgot to add about the curcumin. The fact you are coping in a huge plus, as I said I'm not sure if CBT would of helped but it's there as an option. Hope the hearing aids help as well. Good luck
Here is some insight into what these arrogant shrinks think about us:
Meet Rilana Cima:
And Dyon Scheijen:
Rilana Cima: 'I am a psychologist and started looking at pain and phobic symptoms. Exposing to it helps people get rid of a phobia, just think of aspider phobia. ' Thus, Cima et al. developed an exposure-based treatment.
"Many people with tinnitus are going to mask the sound, they are going to use noise." And this is what Dyon Scheijen, who is working with Rilana Cima said: "With tinnitus a signal is given every time: This is not good for you. If we can change that with cognitive behavioral therapy and allow the sound, we will ensure recovery. "
They think the reason it bothers us is because it is like a spider phobia, which is antattitude that can be changed by not using masking and getting used to it. How stupid can these people be? Who would actually give an idiot like this the time of day? These are people with high paying jobs that are actually useless and are causing damage to us as a community.
At the end of the day, their approach to tinnitus is that it is our fault that it bothers us because we are letting it bother us, which is not right.
Even if this was right, why would we need to pay someone to tell us to not let it bother us? That's what CBT is, just listen to your tinnitus and accept it and don't let it bother you. Why do we need them to tell us this in an expensive therapy session? It's a scam.
Why aren't these pricks going around and lobbying the medical community to stop prescribing anti-depressants that cause tinnitus and recommending CBT, which that would actually be useful for?
That would be a better use for their shrink bullshit.
It should go like this:
I'm sad -> doctor -> CBT
Not like this:
I'm sad -> doctor -> anti-depressants -> tinnitus -> I'm sadder and stressed from tinnitus -> CBT
Notice the latter makes more money for those involved.
Been going to CBT every other week for one year. I can't say it has stopped or lower the tinnitus but it does give me some answers to negative thinking. If you have a negative thought you need to have a rational response. Example; this sucks, why me. I hate my life. Rational response: OK it is what I have, I can accept it. There's a lot of other really great things in my life I just need to accept, adjust and proceed with life. It shows you how to slap yourself and stop being so self centered. There are things are worse than tinnitus. Mine is high pitch hiss 24/7.
My friend has ALS, now that really sucks. My lousy tinnitus is peanuts in comparison.
Been going to CBT every other week for one year. I can't say it has stopped or lower the tinnitus but it does give me some answers to negative thinking. If you have a negative thought you need to have a rational response. Example; this sucks, why me. I hate my life. Rational response: OK it is what I have, I can accept it. There's a lot of other really great things in my life I just need to accept, adjust and proceed with life. It shows you how to slap yourself and stop being so self centered. There are things are worse than tinnitus. Mine is high pitch hiss 24/7.
But that's not what they are selling it is. They are selling it as a treatment for TINNITUS and characterizing the mental distress it causes us as a phobia, an irrational fear. Do you agree that the distress it causes is based on an irrational fear? Answer that question.
You are right about that, it doesn't strike me right for anyone to say that the distress tinnitus causes is based on an irrational fear. That is horseshit. Anyone who says that should be put in a chamber with tinnitus sounds blasting 24/7.
My therapist says point blank that I they are not here to stop my tinnitus noise but maybe they can help with my reaction towards it.
Maybe we are just weak people who seek CBT, but we are creatures who need other people to help with certain situations. It's your choice to go it alone or have someone to talk to.
As far as them getting paid, why not? It's my choice to pay him.
You are right about that, it doesn't strike me right for anyone to say that the distress tinnitus causes is based on an irrational fear. That is horseshit. Anyone who says that should be put in a chamber with tinnitus sounds blasting 24/7.
Well man, that is what I'm arguing against, and it is horseshit. I'm not arguing against seeing a therapist or a mental coach in general if that's what you want, but that is the basis for CBT in relation to tinnitus, that is literally what they believe and it is essentially the standard of care right now. These evil people are making careers out of selling this notion and it is causing harm to the overall patient community.
Are you implying the CBT is overused? You may be correct. I just saw a TV commercial that is using CBT for weight loss. I think it was called Loom?
Why not just put the fork down. Lol.
Peace my friend.
CBT worked for me (in addition of medication). But I had setbacks due to issues with my medication (dropping plasma levels..).
So I decided that I needed something better than medication alone. I'm sure that the medication calmed my feelings on T & H. However when things went south with medication the feelings on T & H
So I started CBT again during the current set-back, it helped me to realize that one day the meds will be ok again and my feelings will become less/better.
But as said I won't trust my medications alone anymore, so we started ACT (Acceptance and Commitment Therapy). And this is helping a lot; Basically I decided to say "T you are annoying, you are the beast that made me suicidal.. But this time I accept the feelings you are giving me, and will pick up my life with you and your feelings".
I'm in the early stage of the therapy but I think this will help me more than CBT alone. As now I decide to continue life with these feelings instead of getting them away by trying to think positive.
I understand the "mental" aspect. For example I have seen it where people say to keep living your life as if one does not have tinnitus.
For example for me would be to keep playing the drums and wearing headphones at the gym which GUARANTEE spike city and extreme pain / discomfort for quite a while.
So am I supposed to carry on anyways just to say *F* you tinnitus, I am going to win beating my chest to prove what?
The physics of it, since for a lot of us there is an aspect of hyperacusis involved as well, you are directly or indirectly pumping excess sound into one's ears.
Same goes for TRT. 2 snake oilists attempted to fit me with hearing aids and caused major spikes on both occasions. It has been said headphones will make one's tinnitus worse.
According to Dr. Hubbard's video ear buds are worse than full head covering headphones.
Let's look at the makeup of hearing aids. A fiber wire leading to tiny ear buds that go deep into your ear canal. Why should this not aggravate things? Did I not read in another topic that Jastreboff, the father of TRT, said that it was ok to use ear buds and apps? Kinda makes sense when you think about it.
I remember when I saw a practitioner who wanted to charge $4500 for hearing aids. Actually charged me for a hearing test when I had had 6 previous audiograms. And which were free for the most part.
I have a membership and would have been able to purchase digital hearing aids with a discount for $1500 less than elsewhere.
He said ok but would charge $750 to program them. Seriously? To add white noise and chime sounds?
Getting back to the point. Is it something you can seriously just mentally get passed? What about the physical parts of this "injury"? So confusing all the different takes and advice out there.
Having said that. I understand people are offering what they believe in or what has worked for them.
@bobvann
Do you have hearing loss? My hearing aids help with my hearing loss. Not sure if the chimes and masking noises do anything to help tinnitus but it's nice to have them ready to play anytime (Work, meetings, train etc) with a touch on your device.
@bobvann
Do you have hearing loss? My hearing aids help with my hearing loss. Not sure if the chimes and masking noises do anything to help tinnitus but it's nice to have them ready to play anytime (Work, meetings, train etc) with a touch on your device.
As I have written on several posts, depending on who you ask, I have what is not really considered hearing loss. A few audiograms have revealed a slight "v'" notch. When I tried the WNGs (hope I got it right) they actually had the hearing aid portion tuned off and it was basically a $,4000 white noise & chimes sound player. Just like using apps & ear buds it made my head scream more rather than help.
I use the term snake oil & snake oilists quite a bit. Where else can you spend thousands of dollars and get nothing in return.
Cochrane Review: Cognitive behavioural therapy for tinnitus Background
Tinnitus affects up to 21% of the adult population with an estimated 1% to 3% experiencing severe problems. Cognitive behavioural therapy (CBT) is a collection of psychological treatments based on the cognitive and behavioural traditions in psychology and often used to treat people suffering from tinnitus.
Objectives
To assess the effects and safety of CBT for tinnitus in adults.
Search methods
The Cochrane ENT Information Specialist searched the ENT Trials Register; CENTRAL (2019, Issue 11); Ovid MEDLINE; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 25 November 2019.
Selection criteria
Randomised controlled trials (RCTs) of CBT versus no intervention, audiological care, tinnitus retraining therapy or any other active treatment in adult participants with tinnitus.
Data collection and analysis
We used the standard methodological procedures expected by Cochrane. Our primary outcomes were the impact of tinnitus on disease‐specific quality of life and serious adverse effects. Our secondary outcomes were: depression, anxiety, general health‐related quality of life, negatively biased interpretations of tinnitus and other adverse effects. We used GRADE to assess the certainty of evidence for each outcome.
Main results
We included 28 studies (mostly from Europe) with a total of 2733 participants. All participants had had tinnitus for at least three months and their average age ranged from 43 to 70 years. The duration of the CBT ranged from 3 to 22 weeks and it was mostly conducted in hospitals or online.
There were four comparisons and we were interested in outcomes at end of treatment, and 6 and 12 months follow‐up. The results below only refer to outcomes at end of treatment due to an absence of evidence at the other follow‐up time points.
CBT versus no intervention/wait list control
Fourteen studies compared CBT with no intervention/wait list control. For the primary outcome, CBT may reduce the impact of tinnitus on quality of life at treatment end (standardised mean difference (SMD) ‐0.56, 95% confidence interval (CI) ‐0.83 to ‐0.30; 10 studies; 537 participants; low certainty). Re‐expressed as a score on the Tinnitus Handicap Inventory (THI; range 0 to 100) this is equivalent to a score 10.91 points lower in the CBT group, with an estimated minimal clinically important difference (MCID) for this scale being 7 points. Seven studies, rated as moderate certainty, either reported or informed us via personal communication about serious adverse effects. CBT probably results in little or no difference in adverse effects: six studies reported none and in one study one participant in the CBT condition worsened (risk ratio (RR) 3.00, 95% CI 0.13 to 69.87). For the secondary outcomes, CBT may result in a slight reduction in depression (SMD ‐0.34, 95% CI‐0.60 to ‐0.08; 8 studies; 502 participants; low certainty). However, we are uncertain whether CBT reduces anxiety, improves health‐related quality of life or reduces negatively biased interpretations of tinnitus (all very low certainty). From seven studies, no other adverse effects were reported (moderate certainty).
CBT versus audiological care
Three studies compared CBT with audiological care. CBT probably reduces the impact of tinnitus on quality of life when compared with audiological care as measured by the THI (range 0 to 100; mean difference (MD) ‐5.65, 95% CI ‐9.79 to ‐1.50; 3 studies; 444 participants) (moderate certainty; MCID = 7 points). No serious adverse effects occurred in the two included studies reporting these, thus risk ratios were not calculated (moderate certainty). The evidence suggests that CBT may slightly reduce depression but may result in little or no difference in anxiety or health‐related quality of life (all low certainty) when compared with audiological care. CBT may reduce negatively biased interpretations of tinnitus when compared with audiological care (low certainty). No other adverse effects were reported for either group (moderate certainty).
CBT versus tinnitus retraining therapy (TRT)
One study compared CBT with TRT (including bilateral sound generators as per TRT protocol). CBT may reduce the impact of tinnitus on quality of life as measured by the THI when compared with TRT (range 0 to 100) (MD ‐15.79, 95% CI ‐27.91 to ‐3.67; 1 study; 42 participants; low certainty). For serious adverse effects three participants deteriorated during the study: one in the CBT (n = 22) and two in the TRT group (n = 20) (RR 0.45, 95% CI 0.04 to 4.64; low certainty). We are uncertain whether CBT reduces depression and anxiety or improves health‐related quality of life (low certainty). CBT may reduce negatively biased interpretations of tinnitus. No data were available for other adverse effects.
CBT versus other active control
Sixteen studies compared CBT with another active control (e.g. relaxation, information, Internet‐based discussion forums). CBT may reduce the impact of tinnitus on quality of life when compared with other active treatments (SMD ‐0.30, 95% CI ‐0.55 to ‐0.05; 12 studies; 966 participants; low certainty). Re‐expressed as a THI score this is equivalent to 5.84 points lower in the CBT group than the other active control group (MCID = 7 points). One study reported that three participants deteriorated: one in the CBT and two in the information only group (RR 1.70, 95% CI 0.16 to 18.36; low certainty). CBT may reduce depression and anxiety (both low certainty). We are uncertain whether CBT improves health‐related quality of life compared with other control. CBT probably reduces negatively biased interpretations of tinnitus compared with other treatments. No data were available for other adverse effects.
Authors' conclusions CBT may be effective in reducing the negative impact that tinnitus can have on quality of life. There is, however, an absence of evidence at 6 or 12 months follow‐up. There is also some evidence that adverse effects may be rare in adults with tinnitus receiving CBT, but this could be further investigated. CBT for tinnitus may have small additional benefit in reducing symptoms of depression although uncertainty remains due to concerns about the quality of the evidence. Overall, there is limited evidence for CBT for tinnitus improving anxiety, health‐related quality of life or negatively biased interpretations of tinnitus.
Plain Language Summary
What is the aim of this review?
The aim of this Cochrane Review was to find out if cognitive behavioural therapy (CBT) is effective for tinnitus. Cochrane researchers collected and analysed all relevant studies to answer this question.
Key messages
There is some low‐ to moderate‐certainty evidence that CBT may reduce the negative impact that tinnitus can have on quality of life at the end of treatment, with few or no adverse effects (although further research on this is needed).
What was studied in the review?
Tinnitus is the perception of sound in the ear or head without any outside source. It is often described as a ringing, hissing, buzzing or whooshing sound. Tinnitus is mostly managed with education and/or counselling, relaxation therapy, tinnitus retraining therapy and ear‐level sound generators or hearing aids. CBT is a form of talking therapy that aims to change the patient's emotional and/or behavioural response to their tinnitus. This review looked at studies of CBT for adults who had had tinnitus for at least three months. Participants in the control groups either received no intervention, audiological (hearing) care, tinnitus retraining therapy or another type of treatment. The review authors studied the effect of CBT on tinnitus‐related quality of life, adverse effects, depression, anxiety, general quality of life and negatively biased interpretations of tinnitus.
What are the main results of the review?
We found 28 relevant studies, mostly from Europe, with a total of 2733 participants. The participants receiving CBT had treatment for between three and 22 weeks (mostly in clinics or online).
When CBT was compared to no intervention there was low‐certainty evidence that CBT may reduce the negative impact of tinnitus on quality of life at the end of treatment. It is not known whether this effect persists in the longer term (six or 12 months). There were few or no adverse effects (only one adverse effect was reported in one participant among seven studies). CBT may also slightly reduce depression (low‐certainty evidence) and may reduce anxiety, although this finding is very uncertain. It is also uncertain whether CBT improves general quality of life or negatively biased interpretations of tinnitus.
Compared to audiological care, tinnitus retraining therapy and other types of treatment, there were findings that CBT probably reduces the negative impact of tinnitus on quality of life. The certainty of this evidence ranged from moderate to low. Where reported, there were few adverse effects and no significant differences between the groups. For depression, anxiety and general quality of life the results were more mixed and the evidence less certain. There is moderate‐certainty evidence that CBT may reduce negatively biased interpretations of tinnitus compared to other types of treatment, but compared to audiological care and tinnitus retraining therapy the evidence is less certain.
How up to date is this review?
The review authors searched for studies that had been published up to November 2019.
So many factors are missing from these types of studies that would include:
Level of tinnitus pitch besides loudness.
What is the cause of tinnitus - is it physical.
Does a physical problem(s) increase stress and hypertension that can also increase tinnitus.
Is the immune system comprised.
Most with pulsatile tinnitus have hypertension.
A - Hypertension Crisis - can cause organ system failures, floaters and vision loss.
With all, but hair cell loss tinnitus, the carotid arteries are comprised.
None of these studies include all the major causes of physical tinnitus.
Heredity, environment, and degenerative disease factors.
Is there oxidant stress.
Many years ago, I received 10/10 fire alarm tinnitus - TTTS, ASD, and hyperacusis from ear syringing.
After a few years, all problems resolved, but tinnitus.
Tinnitus did drop to a 6/10 from ear drum, fiber and muscle healing in ear.
With that, I kept busy and tinnitus wasn't a life controlling problem.
Then about 4 years ago, I received physical high pitch tinnitus from dental treatment.
I have 4 sounds now. PT from an abdominal aortic enlargement that increased carotid pressure caused from hypertension - sudden brief unnoticed raises in blood pressure and that is caused from all my hell. That hell from hypertension also caused vision loss and severe kidney damage.
I know exactly all my problems and causes and it reads like a book.
So CBT is your local healthcare answer without consideration to body over mind.
I worked in healthcare for 28 years and half that time being in emergency care.
Never once did any of us recommend CBT. We recommended equal focus on body and mind.
Focus was too keep busy such as collecting trading cards that can be bought in packs or from the Bay.
Oxidant and immune system improvements.
The proper ways to approach sleep that included changing sides often while sleeping.
The brain makes decisions 100 times a minute and one of those decisions is that brain has decided which side to start sleeping on as you are walking to your bed. Do what your brain senses, as pleasure and comfort - even being little to almost none when being comprised is the best way to get your brain to accept you and all the struggles that is going on.
But the authors' final conclusions are: "Overall, there is limited evidence for CBT for tinnitus improving anxiety, health‐related quality of life or negatively biased interpretations of tinnitus." This doesn't sound like them blindly praising CBT for tinnitus in my opinion. However, I agree with you that researchers should be taking tinnitus characteristics and other health issues into account when looking at CBT for tinnitus but it didn't seem necessary for this Cochrane review.
@Autumnly I added a little more to my post above. My life experience is in body and mind, physiology and every body part in the body. I do also have a degree in finance/economics and have studied updates in bio tech and invested according and made enough years ago to donate to many of my interests which included dogs, cats, children and elder causes. I do understand your thoughts and I always knew where you stand and I know that you don't praise CBT.
CBT is performed naturally,in the mind,from altering and accepting u may have to live a difficult life.How many people who give these courses have got tinnitus,that says enough to me,it took me a long time to wake up, thinking I'm not going to end it after 2 years of this,because it's unrealistic,but this condition takes me to a dark place very often still,CBT is merely an acceptance technique,that u can live in hope.
It's like everything else in this world, if you don't think it will help than it won't. You won't take it seriously, you won't make the required effort, so there won't be any benefit, or point in doing it for that matter.
Fact is, however, it works.
You don't get to be an athlete without committing to good diet and constant exercise. Like everything worth doing in this world it takes effort. At the end of the day tinnitus is a neurological condition - doesn't matter how it started. And that's where the resolution is, in your mind. That's why so many people's tinnitus ends up resolving entirely or to much better levels after committing to CBT. And beyond tinnitus it has many other benefits to all aspects of your life. All those people you read about and see on TV that succeed in life aren't lucky. They're committed.
It's like everything else in this world, if you don't think it will help than it won't. You won't take it seriously, you won't make the required effort, so there won't be any benefit, or point in doing it for that matter.
Fact is, however, it works.
You don't get to be an athlete without committing to good diet and constant exercise. Like everything worth doing in this world it takes effort. At the end of the day tinnitus is a neurological condition - doesn't matter how it started. And that's where the resolution is, in your mind. That's why so many people's tinnitus ends up resolving entirely or to much better levels after committing to CBT. And beyond tinnitus it has many other benefits to all aspects of your life. All those people you read about and see on TV that succeed in life aren't lucky. They're committed.
Tinnitus is caused by damage to cochlear synapses, inner ear hair cells or auditory neurons and nerve fibers. You can't fix it simply by thinking positively. That is complete and utter bullshit, sorry for the terminology, but it's true, you can't fix the damaged auditory system by changing your outlook on life.
Tinnitus is also caused by auditory brain center trying to compensate for lost nerve fiber input and amplifying the noise:
And I don't even hate CBT in all contexts. It has its use, when it comes to psychology, it's a better alternative to dangerous antidepressants and antipsychotics that cause a lot of side effects and health problems. But when it comes to tinnitus, CBT is a complete and utter scam. Tinnitus isn't psychological. It's a physical issue, a neurological one, that has no cure or effective treatment and it should be considered as such. If there is no treatment doctors should just admit that fact instead of prescribing useless palliative therapies to patients that are ineffective.
CBT also gets a lot of funding that could have gone and benefited actual research like inner ear hair cell regeneration and synapse restoration of the research that could actually improve or cure tinnitus. That is disgusting.
I can follow the part about commitment, and trying to be as positive as we can about this ailment, with or without psychological help. But what I quoted above doesn't go well with me. All too often so called CBT professionals make invalid statements about what we can expect. And in my experience that's not a reduction.
Mind you, this is the fault of some professionals, not the concept of CBT per se.
Same for TRT. It all depends on who you get. I am getting fitted for some WNGs on Tuesday. Reason is I have been to the clinic a few times and I trust them more. I will get an honest 90 day trial which is pretty well until May. I don't expect to be cured but if it can at least provide relief it would be something. It will be my 3rd attempt to be fitted. Quiet Please has sated that she tried several "professionals" until finding some success.
As for CBT I think the therapist had no idea how to deal with tinnitus. I was the only one who had it in 2 groups.
But hey! Some folks apparently habituated by simply challenging the "distorted thinking" so what do I know..
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