Why Is There Such a Stigma About Cognitive Behavioural Therapy?

[Ed209]

Just out of interest, what's with all the hate towards CBT on this site? I agree it can be expensive, but it's proven to be effective at reducing some people's suffering and I don't see what's bad about that. As far as tinnitus goes, there's no proven treatment (yet), and there's certainly no cure, so all we have are ways to help one deal with the torment.

CBT is evidence-based, so to dismiss it out of hand seems silly to me. Either one believes in the principles of science or one doesn't, surely? When one starts selecting how and when to believe in science and cherrypicks parts of it to confirm a belief, but also dismisses other parts, then I begin to see some cognitive bias at play. If a treatment came out that had an equal amount of scientific evidence, demonstrating that it could objectively lower tinnitus volume, then I'm sure many would have a lot more faith in what the data would have to say.

To me, this is no different to how flat Earthers operate. They cherrypick their theories whilst ignoring basic science that proves beyond a doubt that the Earth is a globe.

To be objective about something is to be as neutral as possible and to follow what the data has to say, and that's whether it proves or disproves one's beliefs.

 

[JohnAdams]

Imagine approaching some Ukrainians in the Holodomer that are starving to death and offering them pies made out of dirt. Yes, it will fill their bellies, but it doesn't actually feed them. This is how I see CBT.

 

[Ed209]

Imagine approaching some Ukrainians in the Holodomer that are starving to death and offering them pies made out of dirt. Yes, it will fill their bellies, but it doesn't actually feed them. This is how I see CBT.

This doesn't make any sense though and shows a lack of understanding of what CBT is actually for. It seems to me that you are emotionally driven against it for some reason.

What's the point in the scientific process if one would rather choose what to believe in?

 

[Autumnly]

Most people on here are not against CBT in itself but how it's being advertised and what it's promising.

Common misconceptions that CBT and TRT regularly perpetuate are (this is obviously not the case for every therapist):

• tinnitus loudness is never the predominating factor as to whether someone suffers from tinnitus or not
• the main reason as to whether someone sufferers from tinnitus or not is always their emotional reaction
• everyone can learn to tune out their tinnitus, the only people who struggle to do so are negative and don't want to accept their condition
• tinnitus can never be debilitating in itself, it's the emotional response to it that makes it debilitating
• "habituation of emotional reaction" will always lead to "habituation of perception"

I tried CBT and it honestly did nothing and then I got told by other people with tinnitus that I didn't try it long enough or probably didn't have the right attitude so it couldn't work. Nonetheless, I'd still recommend CBT to others.

 

[JohnAdams]

It seems to me that you are emotionally driven against it for some reason.

Alright Captain Spock. You asked a question and I answered it.

Starving people really want food.
Tinnitus people really want silence.

Food=Silence
CBT=Mud pie.

It is a simple analogy.

 

[Ed209]

Most people on here are not against CBT in itself but how it's being advertised and what it's promising.

Common misconceptions that CBT and TRT regularly perpetuate are (this is obviously not the case for every therapist):

• tinnitus loudness is never the predominating factor as to whether someone suffers from tinnitus or not
• the main reason as to whether someone sufferers from tinnitus or not is always their emotional reaction
• everyone can learn to tune out their tinnitus, the only people who struggle to do so are negative and don't want to accept their condition
• tinnitus can never be debilitating in itself, it's the emotional response to it that makes it debilitating
• "habituation of emotional reaction" will always lead to "habituation of perception"

I tried CBT and it honestly did nothing and then I got told by other people with tinnitus that I didn't try it long enough or probably didn't have the right attitude so it couldn't work. Nonetheless, I'd still recommend CBT to others.

I've haven't personally seen CBT being advertised in this way. CBT doesn't promise to allow everyone to tune out their tinnitus, at least not in the UK, and if it is indeed being advertised by someone in this way then it's entirely false. Surely that's a problem with specific clinicians and not the field as a whole, though?

My mom has a friend who received great benefit from CBT for chronic pain, for example. It can't possibly benefit everyone, but I believe the hate against it on here goes way over the top considering it has clinical evidence. It can never replace an outright treatment or cure, but for someone who is absolutely desperate and in a terrible place, mentally speaking, it could very well be a viable option.

I just don't think it's very productive to put the idea into people's minds that it's completely useless and that they shouldn't bother.

 

[linearb]

It is a simple analogy.

To a simple mind perhaps but it's a bad comparison and these are bad posts which if anything after proving @Ed209's point about silly stigmas here.

 

[linearb]

I've haven't personally seen CBT being advertised in this way. CBT doesn't promise to allow everyone to tune out their tinnitus, at least not in the UK, and if it is indeed being advertised by someone in this way then it's entirely false. Surely that's a problem with specific clinicians and not the field as a whole, though?

My mom has a friend who received great benefit from CBT for chronic pain, for example. It can't possibly benefit everyone, but I believe the hate against it on here goes way over the top considering it has clinical evidence. It can never replace an outright treatment or cure, but for someone who is absolutely desperate and in a terrible place, mentally speaking, it could very well be a viable option.

I just don't think it's very productive to put the idea into people's minds that it's completely useless and that they shouldn't bother.

Yeah a lot of people here are upset about a thing that doesn't actually happen very much.

I think unhappy people who are stuck in the tinnitus loop tend to resent the implication that there's another way to experience this, and lash out with furor, impotence and illogic.

I'm really upset about midnight solar flares.

 

[Ed209]

Alright Captain Spock. You asked a question and I answered it.

Starving people really want food.
Tinnitus people really want silence.

Food=Silence
CBT=Mud pie.

It is a simple analogy.

"Alright Captain Spock"

Yea, good one

CBT doesn't claim to cure the psychical ailment, though? Which means your analogy doesn't make much sense. CBT doesn't claim to be the food in your analogy.

It is a way of reducing distress, and that's not to say it will work for everyone either. I just think the hate against it is way overdone on here and it seems to be something I see a lot.

 

[JohnAdams]

CBT doesn't claim to cure the psychical ailment, though?

Neither does the mud pie. Also, declarative sentences don't end in question marks.

 

[JohnAdams]

To a simple mind perhaps but it's a bad comparison and these are bad posts which if anything after proving @Ed209's point about silly stigmas here.

Ok Nero.

 

[Ed209]

Neither does the mud pie. Also, declarative sentences don't end in question marks.

It was a rhetorical question, which means it should end with a question mark. Sometimes I honestly wonder who educated you, John.

 

[Kvothe]

Alright Captain Spock. You asked a question and I answered it.

Starving people really want food.
Tinnitus people really want silence.

Food=Silence
CBT=Mud pie.

It is a simple analogy.

I think it may be oversimplified honestly. In my view, there is an order of preferences:

1. To not have tinnitus
2. To have tinnitus but not let it distract you from everyday life
3. To have tinnitus and obsess over it to you and your family's detriment

I think the point of therapy is to move from 3 to 2, not 3 to 1. I think some people here oversell it, and that's too bad.

There's nothing wrong with pointing out that curing tinnitus is the ideal. But given the lack of a current cure, I understand people's desire to "get on with it."

 

[JohnAdams]

It was a rhetorical question, which means it should end with a question mark.

No way man. Rhetorical questions are still in the form of an interrogative sentence. You cannot just put a question mark at the end of a declarative sentence and call it a rhetorical question. Interrogative sentences ask a question. Rhetorical questions are still questions but those in which the asker doesn't expect a direct answer.

 

[Ed209]

No way man. Rhetorical questions are still in the form of an interrogative sentence. You cannot just put a question mark at the end of a declarative sentence and call it a rhetorical question. Interrogative sentences ask a question. Rhetorical questions are still questions but those in which the asker doesn't expect a direct answer.

Without the question mark the intonation intended in the statement would not be present. Hence, it was rhetorical and I expected no reply. It's used to make a point. Why are we even discussing this?

 

[all to gain]

In hindsight I would have loved to have had intensive CBT 20+ years ago instead have being put on Prozac and given a few sessions of CBT. This was for OCD. I'm sure it could have helped a lot.

Now I have tinnitus, which was brought on by Prozac and another drug. Maybe CBT could have saved me from all the distress I have in my life now due to both tinnitus and other side effects of the drug.

But will CBT help with tinnitus directly? No, of course not. And for someone like me i'm not sure it would even help with the distress caused by it. Tinnitus and OCD are very different animals. But I don't know for sure, as I am yet to try.

I do agree that all the emphasis on coping conditions for tinnitus has taken away from searching for a cure. We have enough coping strategies now. What we need are proper treatments and if possible a cure.

 

[Autumnly]

I've haven't personally seen CBT being advertised in this way.

• "In this way, tinnitus sufferers can function well despite the presence of tinnitus" source

• "The patient can then learn helpful strategies for managing tinnitus effectively and reducing its impact upon their life."
• "There are techniques available to make tinnitus more manageable." source

Ignores that tinnitus can be debilitating in itself and not everyone can "function well" with it (whatever they mean by that), e.g. people who are unable to work due to tinnitus.

• "Research shows it's not the tinnitus but how you respond to tinnitus that determines whether or not you get trapped by tinnitus or go on to gradually habituate. An accepting response to tinnitus calms the alarm brain and helps you cope better now and promote habituation over time. " source
• "Primary to all treatments for tinnitus is the promotion of a neurological process called "habituation," that is, the gradual reduction in perception of tinnitus sounds over time. Through habituation you will come to "ignore" the tinnitus sounds and resume life as usual." source

Most articles on CBT for tinnitus will talk about how it can teach you to "move on/cope well/live unaffected by tinnitus". A lot of vague wording that ignores that CBT doesn't work for everyone and that tinnitus can be debilitating in itself.

Also, CBT for tinnitus usually implies that it's just the emotional reaction to and misinterpretation of the tinnitus that causes the distress, thus we can learn to "cope well" by just changing our reaction. Millions of people are severely debilitated and shouldn't be ignored when talking about the effectiveness of CBT.

As I said, I'd still recommend CBT to someone suffering but it shouldn't be glorified or over-promise what a patient can expect from it.

Mindfulness classes for tinnitus are usually more straightforward:

• "Learn to Live Well with Tinnitus – A Mindfulness Based Cognitive Wellbeing Course for people with tinnitus"
• "you will learn to cultivate greater cognitive well-being with the capacity to recognise unhealthy tinnitus related stress in your system and recover from it sufficiently"- source

Because we can all learn that.

 

[linearb]

Ok Nero.

Ad hominems, the definitive sign of a lack of a rational basis for argument.

 

[Ed209]

• "In this way, tinnitus sufferers can function well despite the presence of tinnitus" source

• "The patient can then learn helpful strategies for managing tinnitus effectively and reducing its impact upon their life."
• "There are techniques available to make tinnitus more manageable." source

Ignores that tinnitus can be debilitating in itself and not everyone can "function well" with it (whatever they mean by that), e.g. people who are unable to work due to tinnitus.

• "Research shows it's not the tinnitus but how you respond to tinnitus that determines whether or not you get trapped by tinnitus or go on to gradually habituate. An accepting response to tinnitus calms the alarm brain and helps you cope better now and promote habituation over time. " source
• "Primary to all treatments for tinnitus is the promotion of a neurological process called "habituation," that is, the gradual reduction in perception of tinnitus sounds over time. Through habituation you will come to "ignore" the tinnitus sounds and resume life as usual." source

Most articles on CBT for tinnitus will talk about how it can teach you to "move on/cope well/live unaffected by tinnitus". A lot of vague wording that ignores that CBT doesn't work for everyone and that tinnitus can be debilitating in itself.

Also, CBT for tinnitus usually implies that it's just the emotional reaction to and misinterpretation of the tinnitus that causes the distress, thus we can learn to "cope well" by just changing our reaction. Millions of people are severely debilitated and shouldn't be ignored when talking about the effectiveness of CBT.

As I said, I'd still recommend CBT to someone suffering but it shouldn't be glorified or over-promise what a patient can expect from it.

I don't think anybody is questioning the fact that it can't possibly work for everyone. Even if it only helps one in a hundred or less, it's still something that may potentially help someone. Ideally, a support forum should try to help people emotionally whilst informing them of potential options to try rather than doing one's best to discredit the only available therapy that has some clinical validity.

For some, the statements above may potentially come true regarding habituation. In cases of truly catastrophic tinnitus, I'd say it becomes a lot less likely, but it's still an avenue to explore. I'd rather see hope given than hope constantly taken away. It's all a matter of perspective. Just because it doesn't work for someone doesn't mean everyone should disregard it.

If I was new to this forum I'd probably never try CBT because it's constantly being ridiculed. All I'm saying is that I fail to see how this helps the masses?

It's nice to see you, Autumnly, BTW. Our discussions are always a proper debate.

 

[linearb]

As long as we're talking about Nero tho:

We drove out in the early morning with the radio jammed on are'n'be
Drive away, drive away, and he turned to me and smiled
Said, how does it feel to be living through the Fall of Rome
And I said it's beginning to feel OK

I could not agree more, it's beginning to feel ok. Life is beautiful!!

 

[JohnAdams]

Without the question mark the intonation intended in the statement would not be present. Hence, it was rhetorical and I expected no reply. It's used to make a point. Why are we even discussing this?

An interrogative sentence must include a question word.
https://en.wikipedia.org/wiki/Interrogative_word
https://examples.yourdictionary.com/interrogative-sentence-examples.html
You are absolutely wrong about this one.

That statement wasn't a question, a rhetorical question, or even an indirect question. It was a declarative sentence with a question mark at the end.

 

[david c]

@Autumnly has perfectly summarised the reasons why the advocates for CBT often make excessive claims for its efficacy and surprise, surprise those advocates very often are those who sell CBT service.

From my own experience of CBT I would say this: if you are offered free CBT sessions for your tinnitus then it might be worth giving them a go. But I would definitely not pay significant sums of money for them - you're much more likely to feel better than you did by spending the money on a nice holiday instead.

 

[Ed209]

That statement wasn't a question, a rhetorical question, or even an indirect question. It was a declarative sentence with a question mark at the end.

To be honest, John, I really couldn't care less. I can't believe you wasted your time looking this stuff up. The question mark was there to make it clear that I was trying to make a point.

Let's not turn this thread into a load of childish arguments that derails the main topic.

 

[GregCA]

Just out of interest, what's with all the hate towards CBT on this site? I agree it can be expensive, but it's proven to be effective at reducing some people's suffering and I don't see what's bad about that. As far as tinnitus goes, there's no proven treatment (yet), and there's certainly no cure, so all we have are ways to help one deal with the torment.

Most (but not all) of the negative comments I see about CBT are from members who have no idea how CBT works, often evidenced by the pretty poor analogies they come up with.

 

[JohnAdams]

To be honest, John, I really couldn't care less. I can't believe you wasted your time looking this stuff up. The question mark was there to make it clear that I was trying to make a point.

Let's not turn this thread into a load of childish arguments that derails the main topic.

Looks to me like @Autumnly eloquently and explicitly refuted some of your claims and that you are also wrong about your use of the English language.

All I see here is a big fat

FAIL.

 

[linearb]

Most (but not all) of the negative comments I see about CBT are from members who have no idea how CBT works, often evidenced by the pretty poor analogies they come up with.

and I think your "not all" is critical, and that if we discount the more idiotic arguments out of hand, people like @Autumnly certainly raise some points I find provoking and valid.

• "In this way, tinnitus sufferers can function well despite the presence of tinnitus" source

• "The patient can then learn helpful strategies for managing tinnitus effectively and reducing its impact upon their life."
• "There are techniques available to make tinnitus more manageable." source

Ignores that tinnitus can be debilitating in itself and not everyone can "function well" with it (whatever they mean by that), e.g. people who are unable to work due to tinnitus.

If we caveated the first statement with "some", changed the second statement to "managing tinnitus, which some patients find effective in reducing", and changed the third to read "more manageable for some people", would you have any objection to these statements?

Also, CBT for tinnitus usually implies that it's just the emotional reaction to and misinterpretation of the tinnitus that causes the distress, thus we can learn to "cope well" by just changing our reaction. Millions of people are severely debilitated and shouldn't be ignored when talking about the effectiveness of CBT.

This here, to me, is a bit of a misrepresentation of my understanding of CBT. That is, no good CBT provider I have worked with, for tinnitus or chronic pain or severe anxiety, has said "you can learn to be distress free". The messaging I've gotten loud and clear is "distress works in concert with conscious thought, and to some extent can be influenced and possibly reduced by understanding where those feedback loops are and manipulating them with willful behavioral and cogitative restructuring." This is consistent with my understanding of the neurological basis from work like

https://www.ncbi.nlm.nih.gov/pubmed/16272874 (this is interesting because the brain region they find benefits in, is implicated in tinnitus distress here, as well as more conclusively in another study I am failing to find at present: https://www.ncbi.nlm.nih.gov/pubmed/27016059)

https://www.ncbi.nlm.nih.gov/pubmed/31697955

https://www.ncbi.nlm.nih.gov/pubmed/30564108

So, if people are selling it as a cure, or more than it is -- I would agree that's a misrepresentation. That hasn't been my experience with CBT providers, especially in the chronic pain arena, who are mostly used to working with people who have a myriad of shitty unfixable problems, and to some extent have a realistic understanding that they're probably going to live with this forever.

Inability to accept that basic reality, I think, leads to a lot of cognitive distortions, excess fear, and excess anxiety which can be dismissed by simply focusing on the current moment. To me there's not a lot of difference between applied CBT and mindfulness or basic meditation or Zen; CBT just has a talk-therapy component that some people find helpful.

I would second your opinion that the MBSR is a good starting point; I am not familiar with the tinnitus specific MBSR and I can see it being a bit more useful; on the other hand, one thing I liked about the MBSR class I took was the diversity of reasons people were there. Some of theme seemed to me to be anxious soccer parents without any significant health problems, but some of those people had issues that made me feel sort of small. There was one woman who had screaming tinnitus from a drug she was taking to treat some other horrible condition, she didn't know if the tinnitus would go away later or not, and she wasn't worried about it because if you're unsure what "later" means or if it exists, it changes your perspective and that makes a powerful impression.

Let's not turn this thread into a load of childish arguments that derails the main topic.

Agree, and I apologize to the extent that I was complicit (which was substantial). But, this is sort of a third-rail issue here, how do we make it not that?

 

[Ed209]

Looks to me like @Autumnly eloquently and explicitly refuted some of your claims and that you are also wrong about your use of the English language.

All I see here is a big fat

FAIL.

What, that CBT is clinically proven to work for some people? I think this only confirms the biases that I talked about earlier. I feel like I'm being eaten up by the echo chamber in all honesty.

Next time you want to use science to help prove a point remember that you can't cherrypick. If you believe in the scientific principles then you have to believe that CBT has some validity otherwise it makes you a hypocrite.

 

[Tom Cnyc]

Because Tinnitus Talk is filled with people that will only accept silence as a solution.

Which is unfortunate - because there is no cure.

I went to CBT for a bit, and OF COURSE IT DOESN'T CURE TINNITUS. What it DID do is give me a place to compartmentalize my grief and stop bothering my wife with it. A time to dedicate to my issues.

@JohnAdams why be so aggressive? Especially since your tinnitus has been cured like 5 times already.

You were going down a pseudo-scientific rabbit hole about how headache noises with harsh frequencies for long exposures can cure tinnitus but proven stress reducing techniques to work on a condition that is exacerbated by stress is a bridge too far for you?

It's been 3 weeks? How are those Koss headphones treating ya?

 

[all to gain]

and to some extent have a realistic understanding that they're probably going to live with this forever.

Inability to accept that basic reality, I think, leads to a lot of cognitive distortions, excess fear, and excess anxiety which can be dismissed by simply focusing on the current moment.

I used to think living in the current moment would be great. That is until I got tinnitus. Then I realised that, for me at least, it sucks and that I love planning for the future and thinking about tomorrow. Reality sucks.

 

[fishbone]

There are techniques available to make tinnitus more manageable.

They are spot on with their information as well. I have intrusive level tinnitus and throughout my years I have used the very same concept that that site talks about and I am able to live a life with this aggressive tinnitus.

The keyword here is "manageable". It's not a cure, but just being able to manage and live a life with tinnitus. Your thoughts and emotions play a vital role when it comes to dealing tinnitus, especially if it's at intrusive levels.