Cognitive Behavioral Therapy

[Eleanor89]

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.

As a psychotherapist who has also worked for our NHS:

CBT was first developed in the 50s by Aaron Beck. It has morphed over the years. It can be integrated and used within many therapeutic models.

Counselling I feel is an important part of the recovery process combined with TRT for tinnitus. And I have had private counselling along with TRT regularly for over 12 months.

I have here in Cumbria accessed TRT within three weeks of my referral. It is accessed easily in my area and is a much needed life line for those who are struggling. I was given in-ear sound generators, hearing tests every few months, pillow generators, and counselling.

I also have had online meetings with NHS Canterbury hospital who specialise in all hearing difficulties, as part of a scientific project on the subject.

I cannot fault the NHS in my journey with tinnitus and hyperacusis. I have recently found out that another clinic for tinnitus has opened at another NHS hospital in Cumbria. As they feel there is a need for it...

 

[Nick47]

As a psychotherapist who has also worked for our NHS:

CBT was first developed in the 50s by Aaron Beck. It has morphed over the years. It can be integrated and used within many therapeutic models.

Counselling I feel is an important part of the recovery process combined with TRT for tinnitus. And I have had private counselling along with TRT regularly for over 12 months.

I have here in Cumbria accessed TRT within three weeks of my referral. It is accessed easily in my area and is a much needed life line for those who are struggling. I was given in-ear sound generators, hearing tests every few months, pillow generators, and counselling.

I also have had online meetings with NHS Canterbury hospital who specialise in all hearing difficulties, as part of a scientific project on the subject.

I cannot fault the NHS in my journey with tinnitus and hyperacusis. I have recently found out that another clinic for tinnitus has opened at another NHS hospital in Cumbria. As they feel there is a need for it...

This just infuriates me more to be honest. I'm in Chesterfield, 30 minutes from huge cities like Sheffield, Nottingham and Derby. Yet I've asked the mental health nurse, 2 GPs, 2 ENTs and one balance consultant and received silence and looking sideways, then changing the subject.

So it seems randomly it is available in only a few areas of the country. I cannot work since mine worsened. I have hyperacusis along with the tinnitus. Therefore I'm not earning. Therefore £2,000 - £3,000+ is not possible privately.

What worries me (and angers) is I see a very worrying trend called mobile apps to solve this issue. Of course these are not developed by people with severe tinnitus/reactive tinnitus or hyperacusis, not to mention hearing loss. It is one of the most ill thought out treatments one could imagine. To say it discriminates is an understatement and in 2022, in the realms of equality, it is astonishing.

Yes, tele medicine can work only in some cases.

I can't tell you how much displeasure this brings me!

 

[Nick47]

I received some very honest and candid information today from a national training provider to audiologists in the UK. I will not name the provider nor staff member.

Brace yourselves as it does not make good reading. I will summarise in bullet point form:

• No training provided to audiologists to support people with tinnitus, barely touched upon in their degree
  
• They were devastated at sudden death of Professor David Baguley
• Debbie Featherstone is one of a few with a good track record for CBT and operates on a private basis
• Huge drop off in audiology degrees
• Most graduates go straight to private sector due to better salaries
• Huge drop off of overseas audiologists
• Government funding now at low levels

I hope this sheds some light on the situation for those in the UK, although it's dark reading for sure!

 

[momus]

Actually it makes for excellent reading! Facts are what we need, not hearing from snake oil selling charlatans who seem to be attracted to this disorder like flies are to, you know, that brown stuff. The first page of this thread explains all we need to know about CBT, and I doubt anything has changed since then.

Now years ago there was something similar, yet very different. The way it was described to me was that it consisted of very large amounts of initial counseling, and people who may receive a benefit from this treatment were selected. They would put white noise generators on people's ears (outside, not inside) and the patients would keep them on 24/7 for 1 or 2 years. Maybe they were taken off for showering or swimming, I can't remember.

The noise generators would be tuned to a frequency and volume that matched that person's tinnitus. Counseling session check-ins would occur occasionally to see how things were going and make adjust things if needed. Then the white noise generators were taken off. The hope was that the brain had reprogrammed itself, and even though the tinnitus was still there, the person's perception had so changed so that they were no longer aware of it. The treatment was very expensive and took a large amount of commitment, but I think the science behind it made sense.

 

[Nick47]

Cognitive behavioural therapy (CBT) is indicated for some patients, but availability of tinnitus-specific CBT in the UK is poor. The evidence base is strongest for a combination of sound therapy and CBT-based counselling, although clinical trials are constrained by the heterogeneity of patients with tinnitus.

Tinnitus - Summary

At least it's acknowledged.

 

[gameover]

CBT is nonsense. You have to be like infantile or gullible to fall for it. I mean I envy those that can be helped with it, but c'mon.

To think some people made careers of it...

 

[Nick47]

CBT is nonsense. You have to be like infantile or gullible to fall for it. I mean I envy those that can be helped with it, but c'mon.

To think some people made careers of it...

@gameover, what better do we have?

 

[DaveFromChicago]

CBT is nonsense. You have to be like infantile or gullible to fall for it. I mean I envy those that can be helped with it, but c'mon.

In the spirit of Swift's "Modest Proposal", I am considering parking the car in the garage with the door closed and running the ignition for precisely how long it would take for the carbon monoxide to kill off enough of my brain cells (but no more) such that I would be permanently stupefied into lovingly embracing these CBT "methods".

To think some people made careers of it...

A very telling point, @gameover; it exactly reflects my sentiments.

I have a very serious ethical issue regarding someone who would knowingly charge (at least around here) $180.00 an hour for providing a "service" that involved no more than what a sympathetic bartender at the local corner bar could offer (or, who is too obtuse and unwitting to recognize this).

CBT is the last effort of psychotherapy to remain even marginally relevant when in fact it is as obsolete as the old-time Black & White TV Sets.

 

[gameover]

@gameover, what better do we have?

Placebo. Free, or way cheaper.

Actually it makes for excellent reading! Facts are what we need, not hearing from snake oil selling charlatans who seem to be attracted to this disorder like flies are to, you know, that brown stuff. The first page of this thread explains all we need to know about CBT, and I doubt anything has changed since then.

Now years ago there was something similar, yet very different. The way it was described to me was that it consisted of very large amounts of initial counseling, and people who may receive a benefit from this treatment were selected. They would put white noise generators on people's ears (outside, not inside) and the patients would keep them on 24/7 for 1 or 2 years. Maybe they were taken off for showering or swimming, I can't remember.

The noise generators would be tuned to a frequency and volume that matched that person's tinnitus. Counseling session check-ins would occur occasionally to see how things were going and make adjust things if needed. Then the white noise generators were taken off. The hope was that the brain had reprogrammed itself, and even though the tinnitus was still there, the person's perception had so changed so that they were no longer aware of it. The treatment was very expensive and took a large amount of commitment, but I think the science behind it made sense.

TRT? That's the BS invented by the quack Jastreboff.

 

[Joe Cuber]

TIL I must be gullible or infantile...

 

[Hardwell]

In the spirit of Swift's "Modest Proposal", I am considering parking the car in the garage with the door closed and running the ignition for precisely how long it would take for the carbon monoxide to kill off enough of my brain cells (but no more) such that I would be permanently stupefied into lovingly embracing these CBT "methods".

Are you completely against CBT altogether or just in regards to its effectiveness towards tinnitus?

 

[Strawberryblonde]

TIL I must be gullible or infantile...

And me...

 

[gameover]

TIL I must be gullible or infantile...

And me...

I really did not want to sound like smartass and disparage those who think CBT helps. I guess I did (my jaded/angry me surfaced again) - I apologize.

I don't know, I question it is CBT that helps you, maybe it is just time? Or maybe it addresses something in your life you are otherwise missing (trusted person to talk to?). I have no idea, really. What I know it does not help me. Maybe my case is harder for some reason. Not necessarily tinnitus but psychological profile. I concede I don't really know why it does not work for me.

That being said, I continue to go to a talk/hypnosis therapy with the hope it will somehow eventually help me.

 

[Michael Leigh]

Are you completely against CBT altogether or just in regards to Its effectiveness towards tinnitus?

And me...

@gameover, what better do we have?

To @Hardwell, @Strawberryblonde, @Nick47. Please be careful when corresponding with people that are adverse to TRT, CBT, sound therapy, counselling and even medication to help with tinnitus management. These treatments are not cures for tinnitus but they can often be immensely helpful in the habituation process. They require a person to have an open mind and to think positively, they are some of the best treatments to help people cope with tinnitus.

Engaging with people that close themselves off from being positive and are not receptive to such treatments, can lead to you having doubts that they will not help you, especially if you have never tried them as I have and corresponded with people that successfully habituated using these treatments. Please remember, tinnitus and hyperacusis are greatly affected by our mental and emotional wellbeing. I cannot express enough, the importance to think positively and to have an open mind. This is where the habituation process starts.

I wish you well,
Michael

Tinnitus and the Negative Mindset | Tinnitus Talk Support Forum
Acquiring a Positive Mindset | Tinnitus Talk Support Forum

 

[RainbowCat]

Here's another infantile or gullible user Of course not all therapies work for everybody, but calling names is definitely not good.

CBT alone helped me but it was not totally effective, I needed an SSRI and other type of psychological therapies to combine it with. In other words, CBT is one of the tools I use, and for me it's very useful... In my opinion it needs to become a habit to have some effect on you, and of course it won't work in every situation (same with mindfulness, and ACT), but you gotta keep trying.

 

[Hardwell]

To @Hardwell, @Strawberryblonde, @Nick47. Please be careful when corresponding with people that are adverse to TRT, CBT, sound therapy, counselling and even medication to help with tinnitus management. These treatments are not cures for tinnitus but they can often be immensely helpful in the habituation process. They require a person to have an open mind and to think positively, they are some of the best treatments to help people cope with tinnitus.

I can't comment on TRT as I've had no experience. And I can't really comment in regards to CBT for tinnitus, but I can easily see how CBT would help some people with tinnitus.

I've had therapy and CBT for PTSD amongst other things. So I can say with complete certainty it was absolutely beneficial and key for me to getting my life back on track at the time.

 

[Michael Leigh]

I can't comment on TRT as I've had no experience. And I can't really comment in regards to CBT for tinnitus, but I can easily see how CBT would help some people with tinnitus.

I have had TRT twice, the full treatment for 2 years and not a scaled down version of it. I also had a short spell with CBT. These treatments work but as I have said, one has to have an open mind and incorporate positivity into their lives. The tinnitus therapist cannot do all the work. I have mentioned this in many posts on my started threads.

If one is going to start TRT, CBT, counselling or any form of tinnitus treatment, then I advise they keep clear of people that are not receptive to such treatments, as their beliefs can quickly become yours.

Michael

 

[Joe Cuber]

I really did not want to sound like smartass and disparage those who think CBT helps. I guess I did (my jaded/angry me surfaced again) - I apologize.

I don't know, I question it is CBT that helps you, maybe it is just time? Or maybe it addresses something in your life you are otherwise missing (trusted person to talk to?). I have no idea, really. What I know it does not help me. Maybe my case is harder for some reason. Not necessarily tinnitus but psychological profile. I concede I don't really know why it does not work for me.

That being said, I continue to go to a talk/hypnosis therapy with the hope it will somehow eventually help me.

Hey @gameover - I know the going is rough for you. Before I took CBT, I had my serious doubts about it, thinking it was a bunch of kum ba ya crap. But I was at a complete low (suicidal ideation, high anxiety, depression, the nine yards), so I gave it an honest attempt. I learned that I knew less about myself and how my mind works than I had drawn the forgone conclusion about.

I described it already on your intro post, but CBT gave me the tools I needed to recognize my own distorted thinking. Like @RainbowCat, it was one of several things that turned me around. It had zero impact on my tinnitus, at least direct impact, but it had a complete impact on how I react to it. Perhaps long term it's helping me heal.

Surprisingly more importantly, it's given me a new approach to how I relate to life in general. I used to be completely high strung about just about everything, I had serious childhood trauma issues (abuse) that I'm coming to terms with, and I'd say that my mental model about how people interact was pretty skewed. So perhaps you're right, a part of me was infantile--the part that understood mental health.

Cheers man, we all suffer and can use each other's support. I know CBT isn't for everyone, but it can make the world of difference for some of us.

 

[DaveFromChicago]

Can anyone please explain why TRT is still being cited as a viable option when it is practised by virtually no one in the Chicagoland Area, which is the third largest city in the US?

Want a good laugh? When out of curiousity I checked to see if it was, for example, available in another Midwestern City such as Detroit, I typed in TRT and was directed to "Testosterone Replacement Therapy."

That is what is so exhausting and in fact just downright crazy about @Michael Leigh; he is constantly parroting forth his endorsement of this when (given what is for me it's Continentwide inacessibility) I might as well be searching for a Komodo Dragon in the Indiana Dunes National Park. What does he expect me to do? Actually attempt to move to England, when given the NHS's state of impoverished bankruptcy it may very well no longer be offered even there?

And, I guess in true 1984 Totalitarian Suppression Mode, I am pilloried for asking why if it is so effective it is so virtually unavailable where I am.

If one is going to start TRT, CBT, counselling or any form of tinnitus treatment, then I advise they keep clear of people that are not receptive to such treatments, as their beliefs can quickly become yours.

And folks, for your own emotional health, ignore this. There has been an excellent book just released about Jim Jones at Jonestown, and this is precisely the sort of intimidating tactic he had in his brainwashing toolbox:

If it doesn't work for you, then you are pitilessly censured with a guilt trip about how this is entirely your fault.

And, in reply to @Hardwell:

I suppose if you really looked like Pierce Brosnan and were frequently hit on by hot women wherever you went but still believed yourself to be repulsive, then CBT might (no facetiousness intended) be a means of acquainting you with a reality about yourself that you had deliberately blocked. No joke - my best friend in College was actor-handsome and would be chatted up by various women in bars but still had major insecurities regarding his attractiveness (I saw this when I was with him and was livid that my role then became that of the proverbial auxiliary wingman).

 

[SamRosemary]

I can't comment on TRT as I've had no experience. And I can't really comment in regards to CBT for tinnitus, but I can easily see how CBT would help some people with tinnitus.

I've had therapy and CBT for PTSD amongst other things. So I can say with complete certainty it was absolutely beneficial and key for me to getting my life back on track at the time.

I completed a pretty intensive 16 week CBT program. And although it didn't help my tinnitus, it helped me so much mentally. I did it for panic disorder and agoraphobia as when my tinnitus came on, my mental health got really bad. I was having panic attacks whenever I tried to go anywhere. It was awful. I'd say just as bad as tinnitus. I feel so much better. CBT helped so much. I think I've had 1 panic attack in the last 2 months. Compared to multiple a week.

 

[Hardwell]

And, in reply to @Hardwell:

I suppose if you really looked like Pierce Brosnan and were frequently hit on by hot women wherever you went but still believed yourself to be repulsive, then CBT might (no facetiousness intended) be a means of acquainting you with a reality about yourself that you had deliberately blocked. No joke - my best friend in College was actor-handsome and would be chatted up by various women in bars but still had major insecurities regarding his attractiveness (I saw this when I was with him and was livid that my role then became that of the proverbial auxiliary wingman).

I just know that without therapy and CBT I would very much still be in a hole with my PTSD. Going through the process of therapy I can see how some people can benefit from it in regards to their tinnitus. But I can also see that it is dependent on the severity of one's tinnitus, and that no amount of therapy would significantly help one's reaction to their tinnitus. So I sit in the middle of this debate about its effectiveness.

 

[Michael Leigh]

no amount of therapy would significantly help one's reaction to their tinnitus. So I sit in the middle of this debate about its effectiveness

The treatments I have mentioned in my previous post, help to improve a person's mental and emotional well-being towards tinnitus and hyperacusis if it is present. With time and adopting a positive mental attitude, will often have a beneficial effect on a person's quality of life. Please remember that tinnitus is an integral part of our mental and emotional well-being and cannot be separated from it. The healing and habituation process, first starts in the mind.

Please read Tinnitus and the Negative Mindset, Acquiring a Positive Mindset.

Michael

 

[DaveFromChicago]

But I can also see that it is dependent on the severity of one's tinnitus, and that no amount of therapy would significantly help one's reaction to their tinnitus. So I sit in the middle of this debate about its effectiveness.

You are entirely correct about how the application of CBT to catastrophic tinnitus (think about Gaby Olthuis and Kent Taylor, among so many other tragic instances) is equivalent to trying to put out a forest fire with a garden hose.

A great sentence from James Joyce in his short story "A Painful Case":

"He felt that he had been outcast from life's feast."

This is a summation of my experience with tinnitus for over 9 years.

 

[UKBloke]

Can anyone please explain why TRT is still being cited as a viable option when it is practised by virtually no one in the Chicagoland Area, which is the third largest city in the US?

FWIW, my regional hospital in the UK doesn't offer TRT. What they offer instead is CBT, which incidentally they offered me but which I've not taken them up on.

I quizzed a senior audiologist there quite hard on the structure of their therapy (that seems to have replaced TRT in some NHS settings) and they assured me it has been adjusted to suit a tinnitus patient.

I'm not here to argue the efficacy of CBT (I'm a bit on the fence with that to be honest) but maybe searching for TRT in the Chicago area isn't the way to go. Perhaps try searching for a tinnitus focused CBT instead?

 

[Nick47]

FWIW, my regional hospital in the UK doesn't offer TRT. What they offer instead is CBT, which incidentally they offered me but which I've not taken them up on.

I quizzed a senior audiologist there quite hard on the structure of their therapy (that seems to have replaced TRT in some NHS settings) and they assured me it has been adjusted to suit a tinnitus patient.

I'm not here to argue the efficacy of CBT (I'm a bit on the fence with that to be honest) but maybe searching for TRT in the Chicago area isn't the way to go. Perhaps try searching for a tinnitus focused CBT instead?

@UKBloke, no tinnitus CBT offered to me. I said I was willing to travel. East Midlands area.

 

[Hardwell]

@UKBloke, no tinnitus CBT offered to me. I said I was willing to travel. East Midlands area.

Bristol has a tinnitus clinic which is of course private but I believe the NHS can refer you there? I know one of the hospitals in Bristol has its own tinnitus 'unit' but I couldn't tell you what they offer.

 

[Michael Leigh]

FWIW, my regional hospital in the UK doesn't offer TRT. What they offer instead is CBT, which incidentally they offered me but which I've not taken them up on.

I think you should have taken the offer of CBT.

@UKBloke, no tinnitus CBT offered to me. I said I was willing to travel. East Midlands area.

If memory serves me correctly, you mentioned a while back, that you were seen by audiologists at two different hospitals. I assumed that you had been offered some form of treatment?

 

[Nick47]

Bristol has a tinnitus clinic which is of course private but I believe the NHS can refer you there? I know one of the hospitals in Bristol has its own tinnitus 'unit' but I couldn't tell you what they offer.

I'm in Chesterfield. A mammoth round trip of about 7 hours.

 

[UKBloke]

@UKBloke, no tinnitus CBT offered to me. I said I was willing to travel. East Midlands area.

My county hospital is Addenbrokes. Can you push for a referral?

I think you should have taken the offer of CBT.

I'm waiting for a follow-up. When they get back in touch, I probably will take up the offer.

 

[DaveFromChicago]

FWIW, my regional hospital in the UK doesn't offer TRT. What they offer instead is CBT, which incidentally they offered me but which I've not taken them up on.

I quizzed a senior audiologist there quite hard on the structure of their therapy (that seems to have replaced TRT in some NHS settings) and they assured me it has been adjusted to suit a tinnitus patient.

I'm not here to argue the efficacy of CBT (I'm a bit on the fence with that to be honest) but maybe searching for TRT in the Chicago area isn't the way to go. Perhaps try searching for a tinnitus focused CBT instead?

Thanks ever so much for this suggestion.

Can you believe it? How foolish of me not to have checked online and found that there are 9 therapists relatively nearby who claim to be practitioners of CBT.

Perhaps I will try one. I have always regarded psychotherapy as akin (in its scientific validity) to Astrology, but perhaps there are mental exercises that may be beneficial.

In fact, the last time I saw a therapist I said that I believed I had turned into a dog; he replied, "In that case, get off the couch." (Rodney Dangerfield)