Cognitive Behaviour Therapy for Tinnitus Distress
CBT is acknowledged to be the only clinical intervention with a strong evidence-base for reducing tinnitus distress. It does so through enabling you to lower, then remove emotional attachment from your experience of tinnitus. When there is a high level of emotion attached to your experience of tinnitus, it is the psychological aspects of having the distressing experience that need to be addressed.
For this reason, it is a qualified experienced psychologist or psychotherapist - additionally knowledgeable about hearing and tinnitus - that has the necessary depth of understanding to help you change from experiencing distress (emotional attachment to tinnitus) to having a neutral attitude towards tinnitus. You might have a highly skilled gardener to look after your garden, but you wouldn't expect your gardener to be skilled at re-wiring your house! There are very few people qualified and experienced in BOTH clinical areas in the UK. Debbie Featherstone who developed and provides the CBT for Tinnitus E-Programme (CBT4T) is one of those few.
When you are seeking CBT to help you, be aware that CBT has evolved over the years, especially so in recent years. There is a family of CBT psychotherapies - not just "CBT".
It is RESISTANCE to experiences that causes distress: Taking a view that circumstances are "the problem" and persisting with an unattainable ideal - "I want it to go away". The more we RESIST - the more it persists. CBT helps us view our circumstances differently through changing the experience we have.
- The brain is predisposed to keep us alive to survive - we would not have survived as a species without the brain's built-in alarm system. It is often referred to as fight, flight or freeze
- Sometimes though, the brain perceives threat to survival when there is none, or commonly, the reaction is an over-reaction. Intellectually, we may even know there is no threat as fact, but knowing intellectually is not enough to switch off the brain's alarm system. We become trapped by our own brain, feel scared, stressed, anxious and worry incessantly! Synaptic connections throughout the brain and autonomic nervous system (neural networks, firing patterns and pathways) establish, strengthen and embed through maladaptive neuroplasticity
- The fight, flight and freeze mechanism has been built-in since we as a species first evolved; the more recent evolution of complex thinking-ability has few, let alone direct synaptic connections to the older parts of the brain, so changing what these older parts are doing to us - even in error or mistakenly and unwanted - is not an automated brain function
- The CBT for Tinnitus E-Programme enables you to cultivate a healthy mindset - away from being PROBLEM-ORIENTED to being RECOVERY ORIENTED to being RECOVERED
- Using the process in this programme grows, strengthens and reorganises synaptic connections (neural networks, firing patterns and pathways) through adaptive neuroplasticity
The CBT for Tinnitus E-Programme
For when tinnitus is a 'big problem' or 'very big problem' reflected in the Tinnitus Functional Index (TFI) as Category 4 or 5
- The CBT for Tinnitus E-Programme is a Neuroscience & CBT Protocol specifically developed for severe and very severe distress experienced because of tinnitus
- It is therefore a defined process, to be used in the order it is presented
- There is a reason for everything used in the course being not only what it is, but where it is in the process
- Users are asked to work through the process at their own pace: no individual can be expected to fit a process - a process has to fit the individual
- Neuroscience is a massive subject of study. Two aspects in particular inform the Neuroscience & CBT Protocol in the CBT for Tinnitus E-Programme: polyvagal theory and neuroplasticity
- CBT itself has evolved. Traditional 2nd wave CBT uses restructuring of thoughts to change feelings. It was the CBT used in my clinics from 2005-2018, some of which was included in the original Tinnitus E-Programme until 2018. It is the form still found in most "CBT for Tinnitus" online and self-help publications to date, particularly by those without a psychology or psychotherapy background, training and experience, but also it is still used by many psychologists and psychotherapists
- Since 2018, it is psychological flexibility that is incorporated in to the CBT for Tinnitus E-Programme, along with additional 3rd wave CBT practices, including those from Acceptance & Commitment Therapy (ACT) that are particularly helpful when learning how to live a normal life alongside tinnitus. These are found to be more intuitive and user-friendly than the old 2nd wave form of CBT by patients. The CBT in this course brings about a change in perspective through adaptive plasticity - this means a recovery-oriented perspective is developed rather than the user being stuck in a problem-oriented mindset. There is additional information in the blog post: ACT, CBT and Neuroscience
- There is no "ban" on using sound enrichment i.e. the playing of music or other everyday background sound in the environment free field or using bone conduction headphones. For those using the CBT for Tinnitus E-Programme, such use spontaneously diminishes, without a need to ban its use
- This course is not limited to CBT; it draws on the latest, up to date relevant research and expertise from other fields including trauma, neuroscience, and consciousness studies
- The course uses predominantly bespoke "CBT tools" developed by Debbie Featherstone, specifically for the CBT for Tinnitus E-Programme
- The expectation is that everyone who completes this process as it is set out reaches at least TFI category 2 (18-31% - tinnitus is a small problem), even those starting with a TFI category 5 (73-100% - tinnitus is a very big problem) See Outcomes
McCracken LM, Vowles KE. Acceptance and commitment therapy and mindfulness for chronic pain: model, process, and progress. Am Psychol. 2014 Feb-Mar;69(2):178-87. doi: 10.1037/a0035623. PMID: 24547803 is a fine example of evidence for using third wave CBT over traditional 2nd wave CBT