Can cognitive behavior therapy help with my tinnitus?

People with tinnitus know all too well the frustrations of this condition. 

While it’s commonly described as a ringing in the ears, tinnitus can sound like a buzz, hiss, or roar, according to the National Institute on Deafness and Other Communication Disorders (NIDCD). This can occur in one ear or both, and the sound of tinnitus may be loud or soft, ever-present or occasional. 

What’s intriguing about tinnitus is that it seems like you’re hearing something in your ear—but no noise is occurring. Something happens in the brain to “create the illusion of sound when there is none,” explains the NIDCD. 

This unpleasant sensation can lead to a surge in emotions. 

That’s the case for Anna Pugh, a UK-based hearing therapist audiologist with Oto, an app designed to treat tinnitus. After a head injury, Pugh developed constant multi-noise tinnitus, which she describes as sounding very much like the internet dial-up noise from the 1990s, at a volume matching moderate conversation. Even as a therapist, Pugh says she “went through all the grief and anger and the denial and struggling.” 

While there’s no cure for tinnitus, there are several potential treatments. For people who have tinnitus accompanied by hearing loss, which is very common, hearing aids can be very helpful, as today's hearing aids even come with tinnitus maskers. For anyone, though, counseling—and in particular, cognitive behavioral therapy (CBT)—is another potential strategy to help people manage tinnitus. 

How can CBT help?  

With this therapeutic technique, people learn to adjust their reaction and response to tinnitus. 

“We can change how we tolerate physical sensations, particularly if they are aversive and causing any anxiety,” says psychologist Johanna Kaplan, PhD, the director of Washington Anxiety Center of Capitol Hill. 

That is, if you embark on cognitive-behavior therapy, the goal isn’t to end your tinnitus—but to change how you respond to the symptom. 

“Someone suffering may think, I cannot do this anymore or will this be my life from now on? We combat this catastrophic-type thinking with cognitive restructuring techniques meant to reduce anxiety caused by these thoughts,” Kaplan explains. 

As the American Tinnitus Association (ATA) puts it, the difference between seeing tinnitus as “no big deal” or “deeply upsetting” rests in the emotional response to the sounds, not the sounds themselves. 

There are other key ways CBT can be helpful, Kaplan says: 

• Building familiarity: CBT therapy often involves gradual exposure to uncomfortable situations. That’s true when it’s used for tinnitus as well. “We work on behavioral exposure exercises that bring on similar sensations to the tinnitus,” Kaplan says. 
• Helping with redirect strategies: "Attentional bias" means you're frequently distracted by a stressor in your life. In this case, tinnitus. Learning redirect techniques can help. “We address attentional bias to the symptoms and how to redirect your attention to reduce symptoms without actually avoiding them,” Kaplan says. 

People often get relaxation training and discover imagery techniques through CBT, according to an article in the Korean Journal of Audiology. This type of therapy is short-term, not ongoing. Some people experience relief within two months, Kaplan says. It’s common to have up to six months of weekly sessions, she says. 

Should you try cognitive behavioral therapy for your tinnitus? 

Research points to CBT as being an effective strategy when it comes to tinnitus. In a 2010 review examining randomized controlled trials, for instance, researchers found participants had improved quality of life if they had CBT, compared to participants with no treatment or other interventions, such as yoga. 

And, a 2014 review of studies published in the Journal of the American Academy of Audiology found that “CBT treatment for tinnitus management is the most evidence-based treatment option so far.” 

Other behavioral treatments

But of course, CBT isn’t a cure-all. “One has to remember it is likely not a panacea,” Kaplan says. Nor is it the only strategy out there. Other behavioral treatments, according to the ATA, include: 

• Mindfulness-based stress reduction (MBSR) — this therapy encourages people to accept their tinnitus, rather than striving to ignore it, per ATA. 
• Acceptance and commitment therapy (ACT) — with ACT, patients learn how to live with tinnitus, Pugh says. 
• ​​Tinnitus activities treatment (TAT)  and tinnitus retraining therapy (TRT) — both these treatments build on CBT, and incorporate sound therapy to either cover up the sounds of tinnitus or help people get used to them. 
• Cognitive reframing uses tools from CBT to help you reframe your emotions around tinnitus.

“I [realized] that we needed to look at different ways of supporting people,” Pugh says, noting that she learned techniques around pain management (since our brain often responds similarly to psychological and physical pain, she notes), bereavement counseling, visualization techniques, ACT, and other counseling methods. 

Where to find behavioral help for tinnitus

There are many places to find a therapist—your doctor or health care provider may be able to make a referral. Listing services, such as Psychology Today or GoodTherapy, are another good place to find someone. 

“Usually any willing CBT therapist can help,” Kaplan says. “You have to have someone well-trained in the model, but the techniques are the same and can be applied to develop an individually-based treatment.” 

Apps for tinnitus

Apps can also help, like Oto, the one Pugh is involved with, but there are many other tinnitus apps that can be helpful. “It doesn't replace seeing a professional, it doesn't replace going to the doctor,” Pugh says. But it can offer ongoing support, available on a day-to-day basis, as a complementary support, she says.

With Oto, Pugh explained, users are exposed to a wide range of treatment strategies, including research-backed therapy, visualization and mindfulness exercises, and access to a wide range of sounds (from motorbikes to nature noises) for sound therapy.  

Having a chronic symptom, with no cure available, can be a lonely and frustrating circumstance. But through behavioral treatment tactics, Pugh says people can adjust their reactions, learning to accept and live with the symptoms—rather than engaging in a constant, doomed-to-fail battle.