Cognitive Behavioral Therapy

[Sven]

Has anyone here had any success with CBT? Has anyone tried it alone? There is a book on the subject concerning tinnitus in Sweden and the writers have A LOT of experience with tinnitus patients. Apparently 40% of patients significantly improve their quality of life, 40% feel an improvement and only 20% register no change at all. (Not from the book, but from CBT in general)

I haven't read the book myself, but if my current condition doesn't improve I'm considering trying the book.

Here it is. (In Swedish, but anyway... ) http://www.adlibris.com/se/product.aspx?isbn=9144042973

 

[Hudson]

In my experience CBT is basically trying to forcefully challenge negative or catastrohpic thinking. It can be a helpful tool to get you through the rough patches, or calm you down from an irrational panic attack. I've had some limited success with it. I guess you would have to be very proactive about it. I have found that time and staying busy are my best weapons.

 

[jazz]

@Sven Hudson is right. You do have to stick with CBT for it to work.

But CBT has a great track record for those that do. (I've never done it.) If you look at some pubmed studies, you'll see CBT helps with tinnitus as well as other medical problems that are worsened by anxiety. You can also find tinnitus books that adopt a CBT-type approach, such as The Tinnitus Toolbox. (See Amazon, if interested.) There are also apps that help you keep track of your negative thoughts. Just go to the App or Android store and type in "Cognitive Behavioral Therapy." Some apps should pop up. But the apps are to be used in conjunction with doing CBT, either with a therapist or on your own. You do need to read how CBT works. (I don't know if you need to go to a therapist or not. But you could try a therapist to learn the therapy, then continue it on your own. That way, you'll know if you're doing the therapy correctly.)

CBT will not reduce your sounds, but it should help your anxiety. Anxiety definitely feeds into tinnitus distress. I'm using a type of TRT (tinnitus retraining therapy) with my hearing aids, which give me white noise all day long. That noise has helped desensitize me to the tinnitus sound. Of course, I still have tinnitus, and it still cycles. (It has always cycled and been reactive to certain sounds.) But I am less irritated by my tinnitus. And that's helped me cope.

I still believe you need to do other things--like exercise, take supplements, watch your diet, sleep well, etc. The psychological part is only a bandaid on the real problem. But it's a bandaid we all need to help us heal and return to normal.

Here's a link to a recent CBT study. In the study, the people attended therapy for their tinnitus for at least four months:

http://www.ncbi.nlm.nih.gov/pubmed/23287811

 

[Sven]

Thank you both for your input. I'm still hoping for this to be a temporary spike, but since I was in a loud environment for 4-5 hours I fear it isn't. I have never before used any therapy or other treatments (except the futile use of Ginko Biloba) and always let my brain work it out on its own.

We'll see if I give it a shot. I'll let you know if I do and whether it works for me.

 

[Anne Hogarth]

Hi, Just think back to the last time you were so engrossed in some activity that you didn't notice your Tinnitus. That is what focussing is all about and that's how you retrain your brain to focus away from tinnitus until eventually you notice that you don't notice it anymore.

 

[Sven]

Just like that?

 

[Anne Hogarth]

Yes, just like that. CBT is all about taking your focus and redirecting it and with practice anyone can do it, anywhere, any time. If you can imagine or visualise you can do it! Changing your negative thoughts to positives, your irritation at your Tinnitus to acceptance. You may be experiencing it but that doesn't mean to say you have to let it control you.
Best advice - find an audiologist who does CBT or Hypnotherapy and get the whole treatment.

 

[Sven]

I might do just that, if nothing changes within a month or so. Thank you!

 

[Markku]

A systematic review and meta-analysis on the efficacy of self-help interventions in tinnitus

Abstract
This study is a review and meta-analysis on the efficacy of cognitive-behavioural therapy (CBT) self-help interventions for tinnitus. Randomized controlled trials were identified by searching in databases (e.g. ISI Web of Knowledge, PubMed, Cochrane Library, and PSYNDEX) and by manual search. Ten studies with 1188 participants in total were included in the meta-analysis. Participants were 49.2 years old and had tinnitus for 5.2 years. Self-help interventions significantly reduced tinnitus distress (d = 0.48) and depressiveness (d = 0.25) when compared with a passive control (e.g. information only and discussion forums) at post-assessment. There was no difference to the face-to-face controls (group treatment). The presence of therapists and the methodological quality of the studies did not influence the results. Sensitivity analysis revealed that there might be a publication bias regarding the comparison to the face-to-face control. However, the results suggest that CBT self-help interventions are an effective treatment for tinnitus distress. Since few studies were identified, this conclusion must be supported by future meta-analyses.


Standardized tinnitus-specific individual cognitive-behavioral therapy: a controlled outcome study with 286 tinnitus patients

BACKGROUND:
Pharmacological treatment of tinnitus cannot be considered well established. Thus, reducing tinnitus severity through behavioral therapy is emerging as a key goal.

METHODS:
A total of 286 patients suffering from persistent and stable tinnitus for four months or longer participated in this controlled clinical multicenter study. The study investigated the efficacy and safety of a standardized treatment involving individual cognitive-behavioral therapy (CBT). Controls were 120 patients waiting to be treated. Therapy was standardized using manualized procedures within the setting of a specifically designed disease management program. The primary outcome measure was the tinnitus change score using an 8-point numeric verbal rating scale. Secondary outcome measures were tinnitus severity as determined by the tinnitus questionnaire score as well as the tinnitus loudness score and the tinnitus annoyance score using 6- and 8-point numeric verbal rating scales, respectively. Following a significant multivariate rank test, these four validated outcome measures were tested in the order given.

RESULTS:
The primary outcome measure, tinnitus change score, showed an efficacy of treatment with an odds ratio of 3.4 (95% confidence interval, 2.6-4.5). Of the treated patients, 84% showed a tinnitus change score improvement, but only 22% of controls did. The secondary outcome measures of tinnitus questionnaire score, loudness score, and annoyance score improved in the treatment group significantly more than in the control group. In the therapy group, the tinnitus questionnaire score was reduced by 50% from a median of 27 to 13.5; in the control group, no change in median tinnitus questionnaire score was observed. The multivariate endpoint of the primary and secondary outcome measures differed significantly (P < 0.0001) between treatment and control groups. The same was true when univariate scores were considered.

CONCLUSIONS:
A structured tinnitus-specific CBT using standardized tinnitus-specific interventions can be an effective individual therapy for the treatment of patients suffering from tinnitus for at least 4 months. The trial was registered at the ClinicalTrials.gov registry (ID: NCT 00719940).


I see jazz linked to the latter study previously.

I wonder if anyone's doctor here has suggested CBT to them? GPs really should have a better handle on tinnitus, laying out the options.

 

[david c]

I think CBT might have some use for tinnitus sufferers but at the same time the last thing I would want personally is someone who didn't really have a clue what tinnitus was like personally trying to foist some positivist agenda on me. The most helpful conversation I had about tinnitus was with an audiologist who had suffered from it herself for a long time - unfortunately not many audiologists have this experience.

 

[MissionForTheCure]

Hi Sven,

Thought I would add on here as I am in the process of completing CBT treatment. Initially I went in because the tinnitus was a real problem and causing me anxiety (physical symptoms) which was not pleasant. As mentioned in another post somewhere, this included dizziness, tension headaches, nausia, heart palputations and a general fast heart rate - my quality of life on the whole was pretty awful and was easily the hardest patch of my life I have gone through. CBT for me has really helped with these anxiety feelings and feeling back to normal. A large part of the treatment is staying focused on the present and to stop catastophising and thinking negatively (which is very difficult to do), along with giving you practical "practices" to do when you are feeling really bad. You do have to be committed to it, which is different to "giving it a go" for a month or two, because you will slip back into old habits if you are not 100% committed to change. It ultimately requires you to work hard on essentially changing the way you react to the tinnitus in the long run (again this is probably the steepest hill any tinnitus sufferrer needs to climb). I am now feeling much better in terms of the anxiety side of things and my quality of life has improved , for this I am very grateful to my therapist who has been excellent! But I am still struggling with the tinnitus and I haven't fully committed to the idea of "not giving a toss about it" (this is my hardest challenge!). I know once I do this, life will become much better!

I guess in my case I still feel like there is something out there that will work for me which is why I am unable to fully commit and I really need to seek the opinion of a couple of experts in the tinnitus medical arena for a thorough diagnosis before I move forward. Even my ENT specialist admitted he was not a tinnitus expert, so this will be my next step in my personal mission!

On a positive note, spent the weekend at the girlfriends, sitting outside and relaxing and forgot about my tinnitus for most of the afternoon, of course my brain made me think back to it, but this is the state we all utlimately need to get too. I read on this forum somewhere "not giving a shit about tinnitus is the same as not having it" - to a large extent I have to agree, and I think CBT may help you on your journey to get to that state of mind!

Good Luck!
Mission

 

[Sven]

Thanks. I might give it a go in the future, but right now I'm handling my T pretty OK. I think my T has worsened a bit, but the anxiety I felt a few weeks ago is gone. Thus CBT doesn't feel as necessary anymore. I apprieciate your input, though.

 

[Markku]

Happy to hear that, Sven.

So often the anxiety related to tinnitus subsides on its own after a little while. Glad it went that route for you too.

July is probably the best month weather wise in .fi and .se, so have a great one mate

 

[MissionForTheCure]

also nice in the UK !!

 

[Neenie]

Just to start off I want to share a quote with you all: Life isn't about waiting fot the storm to pass, it's about learning to dance in the rain. And I think this holds true for all of us. We can't just stop living or enjoying life because we have tinnitus. That storm may never pass, but at the end of it all, do you really want to look back and realise that you spent x number of years worrying about your tinnitus that isn't even influenced by wishful thinking? You can wish it away all you want but that won't make it go away. In fact wishing it away will just make you more miserable in the longer term.

All of us on this forum have the same personality. We all worry about the future, and ask "what if" questions, and catastrophise almost everything. The best treatment we can get is CBT. I hate to write this because I absolutely despise CBT and think that it's a load of crap. But, it most likely isnt. My opinion is that simply thinking positively won't change the situation. However, CBT isn't actually about wishful thinking. It is about becoming more realistic in our thoughts. The aim of CBT is not to eliminate all distressing emotions, rather it's to help you respond appropriately to potentially stressful situations.

Did you know that about 80% of tinnitus sufferers don't worry about it and then very quickly habituate to it and it's no longer even perceived. Why is this? It's because those people don;t worry about the future, they don't concentrate on the noise, they just continue their life as before and then it is long forgotten about. The rest of us....well we just have to learn some coping skills.

I say, go to your local library and get out a book on CBT. Any book, they're all the same. Read it. Then try to apply it. And see if it helps. Just try it. If it doesn't help then you're no worse off than before. Best of luck

 

[LadyDi]

Hi Neenie... I was curious why you are posting this on CBT , given in the past you have said this did not work for you. Have you decided to give it another try?

Personally , getting CBT very early on in my tinnitus treatment was the smartest thing I did, particularly because I had anxiety with T. I don't think it helps everyone but it's a good tool for many. Not that you'll ever hear that from an ENT. I do think a therapist is preferable to a book but whatever works.

 

[Neenie]

Yer CBT doesn't work for me, but that's because I'm lazy and I don't want to practice something that is difficult. And I don't believe any of the "rational" thoughts that you're meant to have. But that is me. It works for everyone else that puts the effort in. I just need to stop being so stubborn and actually believe that something will work! I'm such a pessimist in respect to myself and such an optimist in respect to others! So yer, my anxiety is really all my own fault!

 

[Stina]

Yer CBT doesn't work for me, but that's because I'm lazy and I don't want to practice something that is difficult. And I don't believe any of the "rational" thoughts that you're meant to have. But that is me. It works for everyone else that puts the effort in. I just need to stop being so stubborn and actually believe that something will work! I'm such a pessimist in respect to myself and such an optimist in respect to others! So yer, my anxiety is really all my own fault!

I agree with you on these matters Neenie. As you said, CBT is not about changing the situation but rather your attitude and response to it I think maybe in a way why it annoys you and many other people so much is because CBT does not cure the problem but simply enables you to accept it. I think that if one learns to use CBT in Tinnitus-control it can probably be used in later life in accepting things one cannot change. I also reallt like the theory of thinking of T as an old friend or as a part of oneself.
And it is true that there is no point in worrying. If it does get worse we will start to think about our present T as "the good old mild one" so really maybe we should just enjoy that right it isnt worse
Also, I wanted to ask you whether you have a medical background? I noticed that you are going to do your MA in medicine.

 

[Neenie]

Heya Stina. Yer you're right. Like I said, I know what to think, I just don't believe them so don't bother practising it so it's my own fault. My original degree was Maths/Physics (yes I'm a nerd). Then I did teaching. Then I did Nutrition. And now Masters in Audiology, if I dont suddenly change my mind. As you can see, I get bored easily!

 

[Stina]

Heya Stina. Yer you're right. Like I said, I know what to think, I just don't believe them so don't bother practising it so it's my own fault. My original degree was Maths/Physics (yes I'm a nerd). Then I did teaching. Then I did Nutrition. And now Masters in Audiology, if I dont suddenly change my mind. As you can see, I get bored easily!

Can you really change it like that? I think here in Estonia they also want a medical background. But probably maths and physics are a good base as well as nutrion studies) yeah ive noticed that only very talented and pretty people get T so i guess its really our own fault
Well if you dont believe in CBT it probably wont work but maybe there is smth else that will Also a master in audiology will probably enable you to get your hands on medicines such as AM101 quicker

 

[Neenie]

hahahahahha, that's funny! We had an exchange student from Estonia! Yer, you can just start new degrees but you have to sit entrance exams and if you fail, you dont get in. I've got mine on the 28th Jan for Audiology, I'm freaking out! I have to know so much stuff even before I start. Grrrr....

 

[Stina]

hahahahahha, that's funny! We had an exchange student from Estonia! Yer, you can just start new degrees but you have to sit entrance exams and if you fail, you dont get in. I've got mine on the 28th Jan for Audiology, I'm freaking out! I have to know so much stuff even before I start. Grrrr....

Yeah Estonians are trying to take over the world I also have to study a lot session time!

 

[MissionForTheCure]

It definitely comes down to personal preference but I would recommend seeing a therapist over a book because it is good to talk about your problems and get them off your chest, where you can be actively helped. My CBT therapist had tinnitus herself, but she didn't tell me until the final session! I found it amazing that someone who suffers is able to help in the way she did!

 

[I who love music]

If I didn't excercise, eat right, and do my Cognitive exercises, I'd go back to some loud irritating sounds. I first discovered masking and Cognitive therapy a few years ago with great success. It's crazy how it works so well (for me). See, I believe it's a waste of time trying to ignore T, or self talk my way out of this. I don't think if I had a broken foot I could ignore it or say, "I'll walk on it anyway."
I like to take matters in my own hand. When I did, my T volume went down.
When my T intrudes into my busy activities, I do a few days of ACTIVE LISTENING. The word here is Active.
Here's how it goes.
For a 1/2 hour, I dedicate my brain and ears to listening for silence beyond my T.
It's a total commitment to listening for silence. The idea is to force my brain to listen for silence, and then in the hours of everyday activities, hopefully it is at some level still doing. It must be, because it works.
Again, total commitment. I believe every act is part of the 'treatment.'

1. Find a time when the house is quiet.
2. Put a chair in the middle of a quiet room.
3. Have a clock handy so thoughts of time don't creep into my head.
4. Sit down, relax, clear my mind. No intrusive thoughts.
5. Listen for silence beyond the T.
6. Of course the T is right there, but I listen hard beyond it, around it, over it, and I don't take a break, I don't think of the T, I keep listening to find silence, I don't curse the T, I use it to measure silence. I stare at any object in the room while I do this. (If I close my eyes I get sleepy) I keep listening.

I ran this by a psychologist friend, she said, "Yup."

It's not easy to keep this up for a half hour. It makes a big difference for me.
I always say not to measure the T, but measure the response. Example of how well this exercise works, yesterday, amazingly I only noticed myself responding to my T twice. This is nothing short of a miracle. I will tell you about my responses, it's important that I do. I was in the car and I heard my T, my response was, "Yes, I usually hear it in the car." I don't think this went on for more than a minute. Later at night, I was watching the Olympics on TV. I responded to my T then too, I thought, "I don't remember hearing my T the last time I watched the opening ceremonies."
That's it. That was a good day.

 

[Alex Senkowski]

I'm starting 6 weeks of CBT on Monday. I'm doing it more for all the other disorders of my life and less for managing my T which I have under control for the time being.

 

[derpytia]

I'm thinking about asking my doctors (I'm back home now with my familiar doctors) about Cognitive Behavioral Therapy. I feel that I really do need it because it's gotten to the point where one little thing with my T can ruin my whole week after almost a week of good days and it just completely breaks me down. So I think therapy is a good idea for me.

Have any of you guys gone to CBT before and what can I expect out of it if I decide to do it (which I probably will)? And can I expect the therapist to be nice and empathetic or are they gonna be cold and distant like most doctors I've encountered in my life?

 

[Ken219]

Thank you both for your input. I'm still hoping for this to be a temporary spike, but since I was in a loud environment for 4-5 hours I fear it isn't. I have never before used any therapy or other treatments (except the futile use of Ginko Biloba) and always let my brain work it out on its own.

We'll see if I give it a shot. I'll let you know if I do and whether it works for me.

Tinnitus since 1999. 'always let my brain work it out on its own.' Not sure what that means? You habituated?
It appears you have been okay until this incident? If you have the money and time try CBT. It can't hurt.

 

[SoulStation]

I'm thinking about asking my doctors (I'm back home now with my familiar doctors) about Cognitive Behavioral Therapy. I feel that I really do need it because it's gotten to the point where one little thing with my T can ruin my whole week after almost a week of good days and it just completely breaks me down. So I think therapy is a good idea for me.

Have any of you guys gone to CBT before and what can I expect out of it if I decide to do it (which I probably will)? And can I expect the therapist to be nice and empathetic or are they gonna be cold and distant like most doctors I've encountered in my life?

I would try HBO (Hyperbolic Oxygen Therapy) Especially if your T is noise induced.

 

[jazz]

Have any of you guys gone to CBT before and what can I expect out of it if I decide to do it (which I probably will)? And can I expect the therapist to be nice and empathetic or are they gonna be cold and distant like most doctors I've encountered in my life?

CBT has a very good record of helping people with tinnitus. You might have to shop around for a doctor (probably a psychologist) who has done CBT for tinnitus and is someone you like. And, if you can't find a doctor who's done CBT for tinnitus, I'm sure any qualified CBT practitioner can adapt the therapy to help tinnitus sufferers.

You might start your look with this site since it offers certification for CBT:

http://www.nacbt.org/

And you should also talk to Dr. Hubbard. He's a Ph.D. psychologist and a CBT expert. And he has tinnitus!

Good luck and let us know what you decide to do!

I'd also try the AM-101 trial. That is your only chance for a cure. Everything else will be ameliorative or focused on habituation.

 

[valeri]

I think that dr Hubbard does Skype sessions!
I think that talking to somebody who has the experience can make a huge difference.