Cognitive Behavioral Therapy

[Michael Leigh]

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

Request a referral instead of pushing for it. I don't mean to be pedantic but when dealing with medical professionals, I've found the softly approach to be better. I have been 27 years as a tinnitus out-patient under the NHS and have had very good treatment.

When I was going through 4 years of difficulty habituating for the second time in 2008-2012, my ENT consultant and audiologist would often see me in clinic at a moment's notice. My GP was so helpful and understanding. Having these health professionals in my corner, I never felt I was on my own and completely isolated. It was an extremely difficult time of my life and I will always be thankful to them.

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

Not taking up the offer of CBT, could be interpreted that your tinnitus is not problematic or you are ungrateful, which I don't believe is the case. I think you need to eat a large slice of humble pie and I advise, that you change your attitude. Contact those concerned and say you are having difficulty with your tinnitus and would like to consider trying any treatment they suggest.

Michael

 

[crescentsky]

My experience with CBT has been iffy. When I first got sucked into this nightmare, I was desperate and paid a few sessions with two different therapists. One, I believe fairly well known, even told me that worse things could have happened to me! I should be glad that I have tinnitus instead of other problems. Are you kidding me? And you're a PhD psychologist?

If someone is looking for CBT treatment, if you have insurance that covers therapy, it is probably better to do it through insurance. The ones claiming they are tinnitus specialist psychologists, but not taking insurance, I feel are out there taking advantage of tinnitus sufferers and up-charging their services, easily charging $150 USD for 15 minutes. And they know we are willing to pay for any kind of treatment, especially when we are new into this hellhole.

 

[Nick47]

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

I can ask. It's a 4 hour 20 minute return journey. Were you thinking Zoom sessions for me? Do they have a tinnitus clinic there? They did have one in Leicester but it's closed down now. They are moving that side of things to telehealth and apps, which is poor but saves them time and money. It's all very odd and limited. It seems there are 2 in Carlisle and others in Bristol, Stirling, Cambridge, London. That's more or less it. Most of the population will not have access. The lucky few that do, save thousands.

 

[GregCA]

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

What do you think CBT can help you with?

 

[Nick47]

What do you think CBT can help you with?

The emotional suffering.

 

[Matchbox]

My experience with CBT has been iffy. When I first got sucked into this nightmare, I was desperate and paid a few sessions with two different therapists. One, I believe fairly well known, even told me that worse things could have happened to me! I should be glad that I have tinnitus instead of other problems. Are you kidding me? And you're a PhD psychologist?

If someone is looking for CBT treatment, if you have insurance that covers therapy, it is probably better to do it through insurance. The ones claiming they are tinnitus specialist psychologists, but not taking insurance, I feel are out there taking advantage of tinnitus sufferers and up-charging their services, easily charging $150 USD for 15 minutes. And they know we are willing to pay for any kind of treatment, especially when we are new into this hellhole.

110%.

You lost your child but it could be worse!

It could always be worse. What a load of horseshit.

 

[Hardwell]

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

Unless they have Dr. Shore there herself with the device, then I'd hold off on the 7 hour trip.

 

[UKBloke]

which I don't believe is the case.

Obviously there are details and nuance about the face-to-face conversation I had with the audiologist that I don't go into here. Suffice to say, my reluctance to try CBT at that time was something I and the audiologist cordially agreed between us.

Were you thinking Zoom sessions for me? Do they have a tinnitus clinic there?

I hadn't thought about Zoom but I guess it could be an option. It is a tinnitus clinic, however, it's not separate - it's all just part of audiology. I'm not sure whether they administer the CBT from within audiology or another department within the hospital. If I eventually find out, I'll let you know.

 

[Michael Leigh]

Obviously there are details and nuance about the face-to-face conversation I had with the audiologist that I don't go into here. Suffice to say, my reluctance to try CBT at that time was something I and the audiologist cordially agreed between us.

Thank you for the clarification.

I want people to understand, whether one has TRT, CBT, medication or standalone counselling with a tinnitus therapist, which may also include using white noise generators for sound therapy, they need to have an open mind and be receptive to these treatments. They are not cures for tinnitus. A person needs to incorporate positivity into their life; there are various ways to achieve this, which I have covered in many posts on my started threads.

The habituation process takes time, but I believe a lot can be achieved with patience and not looking for unrealistic expectations.

Michael

 

[Hardwell]

I hadn't thought about Zoom but I guess it could be an option. It is a tinnitus clinic, however, it's not separate - it's all just part of audiology. I'm not sure whether they administer the CBT from within audiology or another department within the hospital. If I eventually find out, I'll let you know.

I don't know how tinnitus orientated CBT delivered throughout the NHS is. I can only imagine it's different from their regular CBT service, which is done by a third party company like VitaMinds, and they primarily offer you Zoom sessions. Waiting list, however, is horrific.

 

[DaveFromChicago]

Obviously there are details and nuance about the face-to-face conversation I had with the audiologist that I don't go into here. Suffice to say, my reluctance to try CBT at that time was something I and the audiologist cordially agreed between us.

I hadn't thought about Zoom but I guess it could be an option. It is a tinnitus clinic, however, it's not separate - it's all just part of audiology. I'm not sure whether they administer the CBT from within audiology or another department within the hospital. If I eventually find out, I'll let you know.

I sometimes wonder, though, what new advice a CBT consultant would have since, out of the sheer necessity for survival, each one of us has had to energetically construct to some degree his/her own CBT methodology just to be able to leave through the goddamn front door in the morning.

 

[Nick47]

My biggest fear, even if I got CBT (statistically unlikely as it barely exists to the masses in the UK), would be feeling patronised. I suppose this depends on the psychotherapist and their experience. If they tell me that tinnitus is just a symptom, not serious, 10% experience it etc., I will walk out and drop them some peer-reviewed scientific literature on tinnitus.

However, any help I can get, I will take, as long as it's helpful. It looks extremely unlikely I will be offered this service anyway for reasons I've mentioned numerous times further up the thread.

 

[Hardwell]

My biggest fear, even if I got CBT (statistically unlikely as it barely exists to the masses in the UK), would be feeling patronised. I suppose this depends on the psychotherapist and their experience. If they tell me that tinnitus is just a symptom, not serious, 10% experience it etc., I will walk out and drop them some peer-reviewed scientific literature on tinnitus.

I would find it very unlikely you'd receive that approach from a therapist who delivered tinnitus counselling. As they'd have a clear understanding from other clients about how debilitating the condition can be.

I did a check in your area (as I'm sure you have many times) and I did see there is a tinnitus support group that meets in Chesterfield, while it may not be completely ideal as there's obviously no CBT being offered, I imagine the people there would be your best bet at finding out what is potentially available to you.

 

[Nick47]

I would find it very unlikely you'd receive that approach from a therapist who delivered tinnitus counselling. As they'd have a clear understanding from other clients about how debilitating the condition can be.

I did a check in your area (as I'm sure you have many times) and I did see there is a tinnitus support group that meets in Chesterfield, while it may not be completely ideal as there's obviously no CBT being offered, I imagine the people there would be your best bet at finding out what is potentially available to you.

Thank you very much @Hardwell.

 

[UKBloke]

out of the sheer necessity for survival, each one of us has had to energetically construct to some degree his/her own CBT methodology just to be able to leave through the goddamn front door in the morning.

I totally agree. I think those of us with years of rubber on the road with this condition will have undoubtedly (and probably unconsciously) shaped aspects of our daily behaviour/routines etc to try and accommodate it.

I've never actually undergone any form of talking therapy but my understanding of it, is that a good therapist will set the context of the session such that it encourages the patient to do most of the talking. If CBT for tinnitus enabled us to maybe focus on the aspects of our behaviour (however tiny) that get us through the day, and build on that, I can see how it might be a positive thing.

 

[Nick47]

think those of us with years of rubber on the road with this condition will have undoubtedly (and probably unconsciously) shaped aspects of our daily behaviour/routines etc to try and accommodate it.

I'm sorry, I didn't realise it's having a day to day impact for you. It's semi-disabled me for sure. I haven't worked since it got significantly worse. The thing is it's well known I'm struggling in ENT/Audiology depts at Chesterfield, Nottingham and Derby. They simply do not have an audiologist in East Midlands as a whole, who specialises in tinnitus, otherwise I would have been referred. I've told them I'm willing to travel, but even with substantial travel, the few remaining are fully booked. David Baguley authored a paper in 2013 clarifying this issue. 10 years later it still stands. There are a few very fortunate ones who have been able to access this, but for the vast majority it's not on offer. It's been suggested to me to have general counselling, but given the general public reaction when you tell them you have severe tinnitus, I'm not sure they will relate.

 

[DaveFromChicago]

I didn't realise it's having a day to day impact for you. It's semi-disabled me for sure.

What has tinnitus done to me? There is a great sentence from James Joyce in his short story "A Painful Case":

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

So, would a CBT therapist say:

"Look, in a prison in Thailand an inmate is forced to get in the fetal position while the guards have a wicker ball that breaks open into two halves; they lock both parts around the inmate so that he is tightly inside the ball, and then bring out an elephant who plays soccer with him. The elephant eventually steps on him and he is literally crushed. The recognition that this could be happening now, as we speak, should motivate you to regard your tinnitus as not so awful as that inmate's plight."

Would this really enable you to reduce your tinnitus stress?

 

[Michael Leigh]

They simply do not have an audiologist in East Midlands as a whole, who specialises in tinnitus

I believe a good tinnitus therapist is one that also lives with the condition and ideally, they should have experience of it being mild, moderate and severe. This way they will have a complete understanding on how tinnitus can impact a person's life and their mental and emotional well-being, because tinnitus cannot be learnt from a book or at medical school.

Through regular counselling, the tinnitus patient will learn how to look at life positively and this takes time. The patient also has to try and help themselves by trying to engage in the things they like to do. Perhaps taking up a new hobby or interest, anything to help take away one's focus from the tinnitus. This is not easy but it can be done if one is willing to put in the effort.

Michael

 

[Nick47]

I believe a good tinnitus therapist is one that also lives with the condition and ideally, they should have experience of it being mild, moderate and severe. This way they will have a complete understanding on how tinnitus can impact a person's life and their mental and emotional well-being, because tinnitus cannot be learnt from a book or at medical school.

Through regular counselling, the tinnitus patient will learn how to look at life positively and this takes time. The patient also has to try and help themselves by trying to engage in the things they like to do. Perhaps taking up a new hobby or interest, anything to help take away one's focus from the tinnitus. This is not easy but it can be done if one is willing to put in the effort.

Michael

@Michael Leigh, I'm willing but cannot get access to one.

 

[Michael Leigh]

@Michael Leigh, I'm willing but cannot get access to one.

What treatment have you been offered for tinnitus?

If ENT or Audiology haven't been able to offer you any tinnitus treatment, then I would consider writing to my local MP and asking if this can be looked into. I would first talk to my GP about this.

Best of luck,
Michael

 

[makeyourownluck]

for the vast majority it's not on offer.

You hit the nail on the head. My GP laughs at the information given out on the NHS website - the services mentioned are never covered in 'our' area.

Most people in the UK won't get offered CBT, nevermind TRT.

 

[DaveFromChicago]

@Michael Leigh, I'm willing but cannot get access to one.

Every week our New York Times has a report regarding lack of funding and the consequent, unprecedentedly deplorable decline in every aspect of the NHS's standard of care (which was, I believe, one of the reasons for the protest regarding the $125 million spent on that Royal Coronation).

@Michael Leigh is a dead end; why don't you just see if there are any reasonably priced CBT therapists online who can offer you a Skype session (and exhibit abilities and techniques that @Michael Leigh may very well be unaware of).

After all, what is so different from a Skype session in your home vs. a face-to-face encounter? The content of the session should not change.

 

[Nick47]

What treatment have you been offered for tinnitus?

If ENT or Audiology haven't been able to offer you any tinnitus treatment, then I would consider writing to my local MP and asking if this can be looked into. I would first talk to my GP about this.

Best of luck,
Michael

Hi @Michael Leigh, some basics about my case: After I sustained worse tinnitus in February 2022, I had a regular hearing test and MRI at Chesterfield. I was then told I would see an inner ear specialist at Derby as I also had dizziness. I had another hearing test. I then was sent to Nottingham and had another hearing test. At each visit I said I was extremely distressed and a few people had recommended CBT. I also enquired about a small supply of Clonazepam to use occasionally. Although acknowledged by kind ENTs/Audiologists at each hospital, I was informed there was no CBT available for tinnitus specifically, and that they don't prescribe any medication for tinnitus.

I have written to my MP who has replied. It was normal political spin really, and how they have funded various amounts for hearing research.

Every week our New York Times has a report regarding lack of funding and the consequent, unprecedentedly deplorable decline in every aspect of the NHS's standard of care (which was, I believe, one of the reasons for the protest regarding the $125 million spent on that Royal Coronation).

@Michael Leigh is a dead end; why don't you just see if there are any reasonably priced CBT therapists online who can offer you a Skype session (and exhibit abilities and techniques that @Michael Leigh may very well be unaware of).

After all, what is so different from a Skype session in your home vs. a face-to-face encounter? The content of the session should not change.

I understand your points too. It's not a treatment and we need better. I was hoping some directed CBT may help improve my emotional responses as there is not much else, you know?

 

[UKBloke]

I'm sorry, I didn't realise it's having a day to day impact for you. It's semi-disabled me for sure. I haven't worked since it got significantly worse. The thing is it's well known I'm struggling in ENT/Audiology depts at Chesterfield, Nottingham and Derby. They simply do not have an audiologist in East Midlands as a whole, who specialises in tinnitus, otherwise I would have been referred. I've told them I'm willing to travel, but even with substantial travel, the few remaining are fully booked. David Baguley authored a paper in 2013 clarifying this issue. 10 years later it still stands. There are a few very fortunate ones who have been able to access this, but for the vast majority it's not on offer. It's been suggested to me to have general counselling, but given the general public reaction when you tell them you have severe tinnitus, I'm not sure they will relate.

No apologies needed, mate. On a day-to-day basis, tinnitus and hyperacusis have been a daily struggle for me for about 2 years; hyperacusis being the game-changer. I don't tend to be too open here about the kind of suffering I endure or the mental impact of it etc. I think the reason for that is probably more to do with my own coping strategies than anything else. I suppose I feel that if I talk online about how bad it is, then I somehow further emphasise or exacerbate the situation, if that makes sense? I guess my mindset is to try plough on regardless.

I'm genuinely shocked having read your experience of the NHS and can't believe some of the things they've said to you. I think I may have mentioned before but my audiology/tinnitus department is actually where David Baguley cut his teeth. On that basis I was expecting an amazing experience when I first got an appointment there but I have to say, my experience has been lackluster. At least they do (or did last time I checked) offer CBT so I guess I'm one of the lucky ones.

 

[Michael Leigh]

I also enquired about a small supply of Clonazepam to use occasionally. Although acknowledged by kind ENTs/Audiologists at each hospital, I was informed there was no CBT available for tinnitus specifically, and that they don't prescribe any medication for tinnitus.

Hi @Nick47,

Thank you for the information on your case thus far. You have certainly been doing the rounds by attending different hospitals which was the right thing to do, but I'm sorry to know you haven't been able to get better help. I don't think all is lost and I have a few suggestions that you might want to consider.

Although your tinnitus increased in February 2022, you are not new to this condition which I believe works in your favour because you have experience with tinnitus. Indeed, it is louder than before but I suspect that the intensity is variable, since you are able to attend this forum quite frequently to write and compile posts. I am not implying that your tinnitus isn't problematic and doesn't cause you distress; I am saying please try to look at what you're able to do as something that is positive. If your tinnitus was loud and intrusive all of the time, this would be a very difficult thing to do. By focusing on the positive things you are able to do in your life is the first step to habituating to tinnitus.

Due to your experience with tinnitus, I don't think a tinnitus specialist will be able to teach you much. Granted, such a person will have more understanding about tinnitus and the way it can affect a person's mental and emotional well-being and their quality of life than a therapist/counsellor that doesn't live with the condition. However, I believe you have a good grasp of this already. If you need more information on this, please go to my started threads and print some of my posts on positivity and not read them online. They are a form of counselling and will help to reinforce positive thinking.

You mentioned the ENTs/Audiologists at each hospital you attended said that there was no CBT for tinnitus. If you are able to get any CBT or counselling under the NHS, my advice is to try it. I believe the counselling will help you to look at life more positively. If memory serves me correctly, you said that you are unable to work at the moment due to your tinnitus? This is understandable and therefore, I think talking to a therapist/counsellor about what's going on in your life will be very beneficial and help you to see things more clearly. A tinnitus therapist does a very similar thing, they talk about life with their patients. It will give you a chance to get things off your chest.

I suggest talking to your GP or ENT doctor again about the possibility of being prescribed Clonazepam. I have found it very helpful since my ENT prescribed it in 2010. I only take it once or twice a month. Less now since I have been taking Epsom salt baths and have stopped using my Tiex machine.

I hope you start of feel better soon.

All the best,
Michael

 

[Nick47]

Hi @Nick47,

Thank you for the information on your case thus far. You have certainly been doing the rounds by attending different hospitals which was the right thing to do, but I'm sorry to know you haven't been able to get better help. I don't think all is lost and I have a few suggestions that you might want to consider.

Although your tinnitus increased in February 2022, you are not new to this condition which I believe works in your favour because you have experience with tinnitus. Indeed, it is louder than before but I suspect that the intensity is variable, since you are able to attend this forum quite frequently to write and compile posts. I am not implying that your tinnitus isn't problematic and doesn't cause you distress; I am saying please try to look at what you're able to do as something that is positive. If your tinnitus was loud and intrusive all of the time, this would be a very difficult thing to do. By focusing on the positive things you are able to do in your life is the first step to habituating to tinnitus.

Due to your experience with tinnitus, I don't think a tinnitus specialist will be able to teach you much. Granted, such a person will have more understanding about tinnitus and the way it can affect a person's mental and emotional well-being and their quality of life than a therapist/counsellor that doesn't live with the condition. However, I believe you have a good grasp of this already. If you need more information on this, please go to my started threads and print some of my posts on positivity and not read them online. They are a form of counselling and will help to reinforce positive thinking.

You mentioned the ENTs/Audiologists at each hospital you attended said that there was no CBT for tinnitus. If you are able to get any CBT or counselling under the NHS, my advice is to try it. I believe the counselling will help you to look at life more positively. If memory serves me correctly, you said that you are unable to work at the moment due to your tinnitus? This is understandable and therefore, I think talking to a therapist/counsellor about what's going on in your life will be very beneficial and help you to see things more clearly. A tinnitus therapist does a very similar thing, they talk about life with their patients. It will give you a chance to get things off your chest.

I suggest talking to your GP or ENT doctor again about the possibility of being prescribed Clonazepam. I have found it very helpful since my ENT prescribed it in 2010. I only take it once or twice a month. Less now since I have been taking Epsom salt baths and have stopped using my Tiex machine.

I hope you start of feel better soon.

All the best,
Michael

Thanks @Michael Leigh. I took very well to your personalised response, and it shows you have looked at my case individually. The advice you have given is good, and really it's a case of accepting what help I can get, even if sub-optimal. It must be frustrating to you at times recommending a course of action that many have difficulty accessing, yet you have personally found benefit from.

Positivity is key, and can be difficult for sure.

Yes, I suppose even when my tinnitus is severe, I can still lie on my back and post on the forum through my smartphone, in a slightly distressed state. I'm not always as erudite as in previous milder times, however.

In terms of improving provision, I would really expect Tinnitus UK to play a role in advocacy. I'm not sure what direction they are heading in.

 

[GregCA]

My biggest fear, even if I got CBT (statistically unlikely as it barely exists to the masses in the UK), would be feeling patronised. I suppose this depends on the psychotherapist and their experience. If they tell me that tinnitus is just a symptom, not serious, 10% experience it etc., I will walk out and drop them some peer-reviewed scientific literature on tinnitus.

I'm afraid that isn't how CBT works, @Nick47 - please check out CBT on Wikipedia.

In particular, there is no reason for CBT to "tell you" things such as "tinnitus is just a symptom": the process starts with identifying what is called "distorted thoughts" (for better or worse, that's the terminology used), and those come from you. The therapist typically doesn't generate "data" for your case: s/he helps you work through the framework and process, but the data comes from you. That's why the same framework can apply to a variety of conditions: same framework, different data.

I've used CBT successfully through books, because it's a process that you can learn and apply yourself. Guidance from a professional won't hurt (I have also met w/ therapists), but if you can read a book, you can already make good progress. Don't think that this is out of reach from you just because you can't find a therapist: you'd be missing out on something that could help you. You might be a good candidate for it because you seem to have a structured thought process.

The book I've used is The Feeling Good Handbook by David Burns. I haven't compared many books so I can't tell whether this is "the best", but I think it is considered a classic. Perhaps you can try it, or rely on "review ratings" to help you pick another book that can help you.

Good luck!

 

[Nick47]

I'm afraid that isn't how CBT works, @Nick47 - please check out CBT on Wikipedia.

In particular, there is no reason for CBT to "tell you" things such as "tinnitus is just a symptom": the process starts with identifying what is called "distorted thoughts" (for better or worse, that's the terminology used), and those come from you. The therapist typically doesn't generate "data" for your case: s/he helps you work through the framework and process, but the data comes from you. That's why the same framework can apply to a variety of conditions: same framework, different data.

I've used CBT successfully through books, because it's a process that you can learn and apply yourself. Guidance from a professional won't hurt (I have also met w/ therapists), but if you can read a book, you can already make good progress. Don't think that this is out of reach from you just because you can't find a therapist: you'd be missing out on something that could help you. You might be a good candidate for it because you seem to have a structured thought process.

The book I've used is The Feeling Good Handbook by David Burns. I haven't compared many books so I can't tell whether this is "the best", but I think it is considered a classic. Perhaps you can try it, or rely on "review ratings" to help you pick another book that can help you.

Good luck!

@GregCA, thank you very much indeed for your help and kindness to me.

Regards,
Nick

 

[Michael Leigh]

Yes, I suppose even when my tinnitus is severe, I can still lie on my back and post on the forum through my smartphone, in a slightly distressed state. I'm not always as erudite as in previous milder times, however.

Thank you for your kind comments @Nick47.

One can have the best treatment that is available for tinnitus but it will only take them so far. I know this, having had TRT twice with counselling and wearing white noise generators for 2 years. I made a very good recovery with the first course of treatment. My severe hyperacusis (with pain) was completely cured and has remained this way. The tinnitus reduced to such a low level that I completely forgot about it until my second noise trauma in 2008. This was a complete nightmare, I had no idea it would take 4 years to habituate for the second time.

There was some improvement after having TRT for the second time, but it wasn't like before, because the tinnitus was still unbelievably severe at times. My ENT and audiologist said I have a severe form of tinnitus that they rarely see in other tinnitus patients. As you know, I was in a lot of distress in 2010 and thankfully my ENT prescribed Clonazepam. It helped a lot but I only used it when the tinnitus was severe. It took another 2 years to get my life back on track and this eventually led to habituation.

This required a lot of soul searching to find what worked best for me, because my tinnitus had changed considerably from what it used to be. However, my previous experience with tinnitus helped as I feel it will help you. Without doubt, I believe the way forward with tinnitus is to incorporate positivity into one's life. This is the reason many of my posts on my started threads are geared towards accentuating positivity. Tinnitus, and to some extent hyperacusis, are an integral part of our mental and emotional well-being. I am not saying one should always think positive but they should try and not let negative thinking become all consuming. Positivity takes time to acquire but I believe, with time and patience it is obtainable.

Michael

 

[Travis Henry]

I hope one day we get real treatments instead of fake ones like CBT and TRT. We're people who count natural remission as the "treatment " helping. If TRT or CBT helped you, you would have been able to do it just the same without it. Like people saying they couldn't have done this or that without God, they could have. Wild. Give yourself and your body some credit. It wasn't TRT or CBT that did it. It was you.

If you can mind over matter and power through the damage you have by putting more sound in your system, you just aren't that bad, and you are lucky. It's so dangerous to promote TRT as a treatment, and talk therapy/CBT is just that. Positive thinking can't change the level of damage you have. Damage control is better than TRT. Time, quiet, rest, and as much sleep as possible, as well as avoiding medications that can make tinnitus worse, are your safest options.

I get pain, and my tinnitus increases from every sound. Let's put more sound in & just think positively about my body getting more and more damaged! Regular sounds can't hurt me. What a crock.