Cognitive Behavioral Therapy

[savister]

I'm looking for a CBT therapist in the Fox Valley / Milwaukee/ Madison area. Willing to travel. If not local to this area, any other CBT therapist recommendations? Thanks.

 

[Frédéric]

Internet-based Cognitive Behavioral Therapy (ICBT) for Tinnitus in the U.S

Objectives: Although tinnitus is one of the most commonly-reported symptoms in the general population, patients with bothersome tinnitus are challenged by issues related accessibility of care, and intervention options that lack strong evidence to support their use. Therefore, creative ways of delivering evidence- based interventions are necessary. This presentation focuses on the adaptation of an Internet-based Cognitive Behavioral Therapy (ICBT) intervention, originally used in Sweden and in the UK, for individuals with tinnitus in the United States. Elements of the ICBT program requiring consideration included (a) adaptations to the platform's features and functionalities, (b) translation into Spanish to extend the reach of the program (c) user acceptability and satisfaction of the program, (d) outcomes from a pilot trial from which it was hypothesized that patients would demonstrate a reduction in tinnitus distress and associated difficulties as measures using standardized self-reported outcome measures, and (e) discussion of the relative merits and appropriateness of the intervention.

Design: The iTerapi platform developed in Sweden was adopted for use in the US. The platform required functional and security features modifications to confirm its compliance with both institutional and governmental regulations, and to ensure it was suitable for the US population. Acceptability and suitability of the materials were evaluated by both hearing healthcare professionals (n=11) and individuals with tinnitus (n=8). A pilot study followed as adults with bothersome tinnitus completed the 8-week program (n=30).

Results: Cultural adaptations included word substitutions, adapting counseling examples for a US population, and modifying the spelling of certain words. The materials were then translated into Spanish and cross-checked. Professional review ensured the suitability of the chapters. Literacy level analysis confirmed all chapters were within the guidelines to be below the 6th grade level for readability. Healthcare professionals and individuals with tinnitus reported favorable acceptance and satisfaction ratings regarding the content, suitability, presentation, usability and exercises provided in the ICBT platform. Preliminary analyses of pilot data indicated a reduction in tinnitus distress and associated difficulties (i.e., anxiety, depression, insomnia) and an improvement in quality of life.

Conclusions: Ensuring that the ePlatform offers the appropriate features and functionalities for the intended population is an essential part of developing Internet-based intervention. The user evaluations and pilot trial outcomes indicated that clinical trials can be performed to assess the effectiveness of ICBT for tinnitus in the US.

Source: https://dc.etsu.edu/etsu-works/7814/

 

[weab00]

CBT is good for coping with the emotional burden of tinnitus, but don't expect it to have any effect on the volume itself. That's the big problem with the push for CBT oriented treatments, doctors think it's a mental condition that can be treated through therapy. You can get there if you're mild or moderate, but severe tinnitus sufferers' only relief will be in the form of medicine.

 

[T Toledo OH]

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:

https://medicalxpress.com/news/2016-01-brain-amplifier-compensates-lost-ear.html

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.

Well if you gave up and are going to sit around waiting for a cure that is great, but for those that want to make their lives better who have a family depending on them then why the hell should you have an opinion on something that might help someone else?

 

[bobvann]

I met with a Psychotherapist / Clinical Counselor yesterday to work in concert with my TRT Audiologist . When we 1st got in contact, I told him what I had done to date including CBT 2 years ago. He had replied that he was not really big on CBT, leaving it at that.

In our meeting, I asked to elaborate further. He replied that it is easily pushed & sold as a blanket solution to many issues.

It truly is... CBT... Oil...

 

[linearb]

In our meeting, I asked to elaborate further. He replied that it is easily pushed & sold as a blanket solution to many issues.

It truly is... CBT... Oil...

Like any kind of therapy, the practitioner and your relationship with them probably matters more than the specific approach used. There are plenty of bad therapists out there selling bad CBT, and also plenty of good therapists who use the same techniques and may not call it CBT. Additionally, the basic notion of what CBT is and how it works has changed pretty radically over the last 20 years.

Long term meditation practice is basically CBT wrapped up in some kind of religious dogma, and various peoples have been using it as a very effective way to reduce suffering and lead a more aware, rich life for thousands of years. Of course, all of these techniques can be learned for free if you have the patience and focus, so all you're really getting from paying a therapist or a teacher is formal structure and subjective feedback on your behavior from someone who is not you. That can be super useful, it can also be a tremendous waste of money, depends entirely on the therapist/teacher.

Before COVID-19, the mediation practice I was going to was "$5 is asked, donation basis, not required". Hardly much of a scam, it barely pays facility fees.

I don't, personally, draw a line between mindfulness meditation and "CBT". They are the same thing. They are paying attention to the current moment and the ebb and flow of the mind, and learning to become more of a passive observer of our distress states than being an active participant in it.

It's certainly true that meditation can take you a lot farther than that -- something like a Samadhi state will not happen from CBT practice -- but it also won't happen for like 99.99% of Westerners that pick up meditation, because building out the mental architecture to access those really profound states is fucking hard and takes years of dedication.

 

[Luman]

I met with a Psychotherapist / Clinical Counselor yesterday to work in concert with my TRT Audiologist . When we 1st got in contact, I told him what I had done to date including CBT 2 years ago. He had replied that he was not really big on CBT, leaving it at that.

In our meeting, I asked to elaborate further. He replied that it is easily pushed & sold as a blanket solution to many issues.

It truly is... CBT... Oil...

I am sorry that CBT did not help you. I used CBT to assist with tinnitus distress and it helped ease my transition to habituation, by equipping me with coping techniques. I am happy to say that it worked for me, and others as well. It does not work 100% of the time for everybody with tinnitus, but studies have shown that it helps the majority who try. Good luck with your new treatment option.

 

[GregCA]

I don't, personally, draw a line between mindfulness meditation and "CBT". They are the same thing.

What do they have in common?

 

[linearb]

What do they have in common?

Most of what I've seen offered as CBT is basically a distillation of Buddhist practices which removes all of the religious dogma and ceremonial aspects, and focuses solely on making a willful effort to be aware of each moment as it arises, without judgement.

Full Catastrophe Living does a deeper dive on this, in terms of being a very practical self-help manual which is very explicitly describing CBT techniques which are directly lifted from various Buddhist practices. This paper explores the link between Buddhism and CBT, and this book is an absolutely stellar deep dive into what's known about the neurology of meditation as it relates to these practices, written from the perspective of an MD neurologist who has spent decades meditating.

Not all CBT is mindfulness focused, and not all Buddhism has much to do with what we think of as "Buddhism" in the US -- because there are thousands of different CBT providers following hundreds of slightly different ideas, and Buddhism arose and evolved over an extremely long time period as a set of different schools with wildly different practices.

So, I wasn't trying to make the case that "CBT is Buddhism"; CBT takes one specific set of practices focused on mindfulness, and then turns it into a therapeutic regimen with measurable outcomes and all the other bullshit that comes along with psychoanalytical work. Meditation at a core level doesn't exactly have a measurable outcome, but I know my life has benefitted a lot from it and I'm not sure I'd still be here if I hadn't turned on to that path hard right when I did, at the worst moments of my tinnitus suffering to date, back in ~2013 / 2014.

 

[bobvann]

I am sorry that CBT did not help you. I used CBT to assist with tinnitus distress and it helped ease my transition to habituation, by equipping me with coping techniques. I am happy to say that it worked for me, and others as well. It does not work 100% of the time for everybody with tinnitus, but studies have shown that it helps the majority who try. Good luck with your new treatment option.

I tried plenty. Kinda sounds like more subject blaming (no offense). In any case, good on you for habituating.

I am curious to come at it from a psychological angle vs simply meditate & do yoga.

Unlike the CBT oilist, this therapist states we can stop anytime if I don't find it productive and most is covered under my health plans so it's worth exploring.

After 4 years I think I'm doomed. I know, I know, negative thinking blah blah blah...

 

[Michael Leigh]

I am sorry that CBT did not help you. I used CBT to assist with tinnitus distress and it helped ease my transition to habituation, by equipping me with coping techniques. I am happy to say that it worked for me, and others as well. It does not work 100% of the time for everybody with tinnitus, but studies have shown that it helps the majority who try. Good luck with your new treatment option.

I am pleased CBT worked for you Luman. Some people don't realize the counselling cannot do all the work. It has to be reinforced with positive thinking and incorporating things you like to do in your life which takes time. The belief that one can read a book on CBT and counsel themselves, when distressed by tinnitus is wishful thinking, because it's near on impossible, if the condition is severe due to the way if affect their mental and emotional wellbeing. A therapist that dismisses CBT and TRT rubbish is a classic example of someone that knows nothing about tinnitus. If they claim to have the condition, it is probably very mild.

Michael

 

[GregCA]

Most of what I've seen offered as CBT is basically a distillation of Buddhist practices which removes all of the religious dogma and ceremonial aspects, and focuses solely on making a willful effort to be aware of each moment as it arises, without judgement.

I don't really know where you look for CBT offers, but they seemed biased towards a type of CBT (specifically Mindfulness CBT, as described in here). I don't exactly know the prevalence of this type, but given the large repertoire available, I'm surprised you'd be mostly exposed to this type, unless you'd specifically look for it.

So, I wasn't trying to make the case that "CBT is Buddhism"

OK. Perhaps this could use a bit of nuance then:

I don't, personally, draw a line between mindfulness meditation and "CBT". They are the same thing.

 

[linearb]

OK. Perhaps this could use a bit of nuance then:

Hyperbole is my friend and nuance is something I have to stagger towards

That said I've worked with, uh... 2 CBT providers in upstate NY, 3 in the greater DC area and one in Vermont over the last 20 years or so and all of them have been focused on mindfulness.

It's probably fairly hard to get a really accurate picture of what the most common forms of "CBT" are; if you take the term literally it is "therapy designed to change behaviors by changing the thoughts under them" and that seems to describe most of what I'd call "therapy" period.

 

[bobvann]

A therapist that dismisses CBT and TRT rubbish is a classic example of someone that knows nothing about tinnitus. If they claim to have the condition, it is probably very mild.

Wow you managed to bash both my therapists! Best go and put your amp & PC tower in your neighbor's house!

 

[AfroSnowman]

Interesting article in today's Washington Post talking about pain reprocessing therapy (PRT). Basically stating the same basic CBT approach to pain as is recommended for tinnitus.

Chronic pain is surprisingly treatable — when patients focus on the brain

 

[DaveFromChicago]

Thanks ever so much for posting this, AfroSnowman.

At first I assumed that this was from a Staff Reporter, and could not believe that his or her Editor would permit the same sort of messy, contradictory and easily empirically refutable commentary (which makes it useless) that we get from Michael Leigh, Jastroboff, Julian Cowan Hill, etc.

I then realized that it is only a personal entry from this Nathaniel Frank character, who supposedly runs a "Project" with the suspiciously New Agey Name, "What We Know".

Internally I replied to this Frank guy, "Look, Capt'n, when I have a Migraine which makes my vision so distorted that I cannot read or drive, no matter how Rhapsodically Positive with the utmost effort I gear myself to be, it will still not result in the slightest improvement to my vision."

So, I'm supposed to "reinterpret pain as a neutral sensation coming from the brain rather than evidence of a dangerous physical condition."

What about when a Migraine also makes me so nauseous that I am doubled up over the toilet vomiting copiously? "Hey, don't worry, this hasn't inconvenienced me in the slightest since it is not a dangerous physical condition."

He also admits that this has been dismissed as "New Age hooey or offensive victim-blaming." I've got news for you, Nathaniel; it still is.

It is so distressing that this asinine placebo junk long promulgated by the abovementioned charlatans is now being taken seriously by Cornell University.

As I reported previously, one poster reported that at a Physician's seminar several Doctors agreed to sit around a conference table and wear headphones that produced typical tinnitus sounds at typically reported volumes. The longest that any Physician could stand this was 9 minutes. So much for the ease with which they could "reinterpret" this as "a neutral sensation."

This is just the same-old junk wine packaged in a spurious new bottle.

God help us in ever removing this hocus-pocus abracadabra as an impediment to researching for a bona fide cure.

 

[Paul1980]

I met with a Psychotherapist / Clinical Counselor yesterday to work in concert with my TRT Audiologist . When we 1st got in contact, I told him what I had done to date including CBT 2 years ago. He had replied that he was not really big on CBT, leaving it at that.

In our meeting, I asked to elaborate further. He replied that it is easily pushed & sold as a blanket solution to many issues.

It truly is... CBT... Oil...

I think that is because at its core CBT isn't tailored to specific conditions. I did it for sleep, and it helped. It was management of thoughts, feelings and habits. That is what a therapist is there to help with, so yes, it could be applied to a number of issues, but doesn't mean it wouldn't be effective for some of them, including this one.

To be honest it was a structured approach as opposed to other therapies, like looking at pictures of butterflies and telling the therapist what you think. I'd rather have the structure.

 

[bobvann]

I posted "CBT Oil" on a YouTube video. Someone asked if it helped with my tinnitus

 

[Nick47]

Seems in Britain CBT is not widely available on the NHS and is something you now need to spend thousands on privately. The silence and blank looks when you are desperate and ask say it all. Disappointing, given the success Michael Leigh has had, however, it's not 2010 anymore!

 

[SmallRonnie]

Seems in Britain CBT is not widely available on the NHS and is something you now need to spend thousands on privately. The silence and blank looks when you are desperate and ask say it all. Disappointing, given the success Michael Leigh has had, however, it's not 2010 anymore!

Surely you can find a cheaper therapist than that. I went to a good therapist who was giving me CBT sessions specifically for tinnitus in Ireland for just €80 a session. I just got 2 sessions and it was good.

I really think CBT is great for tinnitus, especially if it's not reactive. She said it works for the pain too but I disagree. Maybe after a long time it can help with the pain but pain is so much more difficult to ignore than a noise.

I had really good success with CBT for my tinnitus. It's a fairly high loud pitch noise almost all the time. I can hear it over a lot of things but some music does cover it up. My tinnitus is very loud at night. Changing my reaction to it really made it not seem so loud.

 

[NAPman]

I'm on a monthly service with a remote audiologist that combines CBT with TRT (tinnitus retraining therapy). They've had a lot of success. I'm not anxious about tinnitus and plow through it so I don't have too many negative thoughts (getting over being upset for not using earplugs), so I'm more focused on the TRT.

Separate note: I find staying busy and focused on other things helps a lot. When I'm watching a good movie, or working intently, I don't hear tinnitus. It's when the TV program goes to commercial or I get up from my desk to take a break that my brain switches to it. It's incredible how the brain works. Do your best to stay positive, move on and focus on things you enjoy. Each moment of silence, no matter how short, is a success. I've had spikes (having one last couple of days likely due to lack of sleep), and it's frustrating, but you have to be mentally tough and think positive. CBT is all about exactly that. It's your brain and the only way I find I can control it is focus on anything but the tinnitus. When you hear, say, nope... moving on to something.

 

[Nick47]

Each moment of silence, no matter how short, is a success.

That says it all. That is not the case for most people with severe tinnitus.

 

[Nick47]

Well after asking various GPs and ENTs, one finally admitted this week that the NHS have very little audiologists with experience in CBT/TRT working in the field.

Now that said, I can fork out thousands to have it delivered privately. For all the seemingly good advice of posters such as @Michael Leigh, he seems to relate his positive experience in 2010 to current options in 2022. It's simply not available outside of a few limited places.

Whether we've regressed since then I don't know.

 

[Michael Leigh]

Now that said, I can fork out thousands to have it delivered privately. For all the seemingly good advice of posters such as @Michael Leigh, he seems to relate his positive experience in 2010 to current options in 2022. It's simply not available outside of a few limited places.

I understand where you are coming from @Nick47 and I empathise with you. Although CBT and TRT may not be widely available under the NHS, they are still practiced at some hospitals, mine for instance. I have corresponded with people the length and breadth of the UK. In most instances when a tinnitus patient is referred to Audiology from ENT, some form of help is offered, so don't give up.

If you are prepared to travel, then explain this to your GP who might make enquires to refer you to a hospital further afield, which is your right. Ask politely and try not to come across as making demands as it could rub your GP up the wrong way. I have always found this approach to be the best.

I live in Brighton and I'm still an out-patient at my hospital in London.

Best of luck.
Michael

 

[DaveFromChicago]

Seems in Britain CBT is not widely available on the NHS and is something you now need to spend thousands on privately. The silence and blank looks when you are desperate and ask say it all. Disappointing, given the success Michael Leigh has had, however, it's not 2010 anymore!

Today the New Statesman had this article:

"Sick Britain: where have all the workers gone?
An unwell, understaffed country has emerged from the era of pandemic."​

The New York Times, I believe, also had a recent report that over 100,000 health care workers at all levels have left the UK (with the effects of Brexit being one of the causes).

It is now widely accepted that the overall state of the NHS is currently worse than it has ever been since 1945.

Given Britain's increasingly draconian austerity policies, it may only be a matter of time when TRT is no longer available in any NHS hospital (and given it's extremely limited effectuality, I can see why).

Isn't it rather ridiculous of @Michael Leigh to emphatically insist on its greatness when its availability is continually shrinking? What will he say when it is not offered anywhere?

BTW, I've checked around where I am, and it is not possible to get this "treatment" anywhere in the third largest city in the US. I couldn't find anyone who does this even if I wanted to. Is that any indication of its uselessness?

 

[Luman]

CBT, which is short-term, is often lumped together with TRT, which creates the impression that they are very similar, which I do not think is accurate. CBT is a prevalent method of therapeutic learning techniques, the core of which can be applied to many challenging conditions. There are a number of books, videos, and other ways to learn about and incorporate it, very inexpensively, if in-person therapy is not an option.

 

[Nick47]

Today the New Statesman had this article:

"Sick Britain: where have all the workers gone?
An unwell, understaffed country has emerged from the era of pandemic."​

The New York Times, I believe, also had a recent report that over 100,000 health care workers at all levels have left the UK (with the effects of Brexit being one of the causes).

It is now widely accepted that the overall state of the NHS is currently worse than it has ever been since 1945.

Given Britain's increasingly draconian austerity policies, it may only be a matter of time when TRT is no longer available in any NHS hospital (and given it's extremely limited effectuality, I can see why).

Isn't it rather ridiculous of @Michael Leigh to emphatically insist on its greatness when its availability is continually shrinking? What will he say when it is not offered anywhere?

BTW, I've checked around where I am, and it is not possible to get this "treatment" anywhere in the third largest city in the US. I couldn't find anyone who does this even if I wanted to. Is that any indication of its uselessness?

Yes, we are having it dismantled and possibly going the way of America, sadly. A lot of workers left during COVID-19. There was a threat to sack any who did not want the jab, this caused a backlash where ~100,000 staff refused. Some resigned and some fought it and won.

TRT doesn't have much evidence and is not recommended by the BTA.

 

[Michael Leigh]

CBT, which is short-term, is often lumped together with TRT, which creates the impression that they are very similar, which I do not think is accurate. CBT is a prevalent method of therapeutic learning techniques, the core of which can be applied to many challenging conditions. There are a number of books, videos, and other ways to learn about and incorporate it, very inexpensively, if in-person therapy is not an option.

Hi Luman,

Long time, no see. I hope you are keeping well.

As you may know, I have had TRT twice. I also had a short spell of CBT back in 2010. Although the treatments are different, they share some similarities, namely the counselling, which is the most important part of these treatments, because it deals with a person's mental and emotional wellbeing and how they react to the tinnitus.

The counselling part of these therapies helps to remove and demystify the negative thinking that is often attached to tinnitus and hyperacusis. This retraining of the mind takes time and is best done when working with therapist trained in tinnitus and hyperacusis and who preferably lives with the condition in order for the counselling to be of high quality. My hearing therapist was born with tinnitus.

All the best,
Michael

 

[Luman]

Hi Luman,

Long time, no see. I hope you are keeping well.

As you may know, I have had TRT twice. I also had a short spell of CBT back in 2010. Although the treatments are different, they share some similarities, namely the counselling, which is the most important part of these treatments, because it deals with a person's mental and emotional wellbeing and how they react to the tinnitus.

The counselling part of these therapies helps to remove and demystify the negative thinking that is often attached to tinnitus and hyperacusis. This retraining of the mind takes time and is best done when working with therapist trained in tinnitus and hyperacusis and who preferably lives with the condition in order for the counselling to be of high quality. My hearing therapist was born with tinnitus.

All the best,
Michael

Hello Michael,

As TRT is virtually impossible to find in the United States, and most elsewhere outside of the U.K., for the vast majority of people with tinnitus, I was pointing out that CBT is not tinnitus-specific and easily available.

Five years ago I first went for CBT to a therapist who had acquired tinnitus some 15-20 years earlier and had a very bad case of tinnitus distress which lessened with CBT techniques that he modified for tinnitus, which helped to bring about habituation faster. At one point I had a non-CBT therapist who had a long-term case of loud, noise-induced tinnitus, but he had absolutely no idea why tinnitus would bother anybody. I would not recommend seeking a therapist simply due to their having had tinnitus - unless they had dealt with anxiety and other problems due to it.

I still have tinnitus, but my mind ignores it the vast majority of the time and when I do hear it, my reaction is neutral. I would say that I have recovered at least 95% from being bothered by it.

Thank you again, for your positive and helpful posts over the years.

 

[Michael Leigh]

I still have tinnitus, but my mind ignores it the vast majority of the time and when I do hear it, my reaction is neutral. I would say that I have recovered at least 95% from being bothered by it.

Hi Luman,

Thank you for your kind words. I agree with everything you have said. You understand tinnitus and have fully habituated. Although the habituation process is different for everyone, I believe one of the most important things is for a person to adopt a positive mental attitude. This takes time and is not achieved overnight, nor does mean one always has to be positive. The key is not to let negativity become all consuming, as one could find themselves spiralling down into a vortex of confusion and that's not healthy.

If a person is having difficulty managing stress and anxiety, my advice is to talk with their doctor as medication can be very helpful. In addition to this, one should try and involve themselves in things they like to do. Start a new hobby or interest, anything to help take away from focusing on the tinnitus, at least some of the time. Sound therapy can help treat tinnitus and hyperacusis and available in many forms. My favourite are white noise generators.

Take care,
Michael