Cognitive Behaviour Therapy (CBT) is effective in treating a range of conditions. Its origins are in the treatment of people with depression, however it has been successful in treating people with health-related problems, including tinnitus. Tinnitus, the sensation of buzzing, ringing or other noises in the ears or head, is experienced by one in ten people across the UK.

CBT aims to help patients identify links between emotionally distressing feelings, such as fear, anxiety, hopelessness and worry, associated thoughts, behaviours and their physical response to their tinnitus. By encouraging the patient to adapt their responses and reduce the impact of distressing feelings, CBT aims to limit the attention they give to tinnitus rather than completely getting rid of it.

Common responses to tinnitus

When faced with a chronic condition such as tinnitus, many people react by changing their lifestyle in a negative way. Typically, the people we see who are struggling with tinnitus have increased behaviours that are ‘maladaptive’ (and which can cause problems in themselves), and have decreased those that may help them to adjust successfully to tinnnitus. For example, they may turn to alcohol to help them sleep or cope with stress, or they may avoid activities they associate with a worsening of tinnitus. However, prolonged avoidance of activities they once enjoyed leads to a decreased enjoyment of life and increased anxiety as tinnitus is allowed to dictate what a person does. Potentially this may lead to a greater awareness of tinnitus.

The components of CBT

Cognitive component

The cognitive component of CBT refers to thoughts - whether as words, images or memories. For example, what having tinnitus means to a person and what happens to them when they notice it. Some thoughts are unhelpful and these typically involve one or more of a number of common distortions, including:

- All-or-nothing thinking:
Unless I can completely get rid of the tinnitus, it will always be a major problem.

- Overgeneralisation:
My tinnitus was loud when I went out with friends, so it’s always going to be loud when I socialise.

- Being Catastrophic:
Tinnitus has ruined my life and I’ll never be happy again.

Constant unhelpful thinking styles may make things worse so we teach patients to recognise their own counterproductive thinking patterns, to challenge them and develop more helpful ways of thinking.

Behavioural component

In the behavioural component, we encourage patients to reduce their reliance on unhelpful behaviours such as drinking or avoiding activities the patient had previously enjoyed. At the same time, the use of strategies that reduce the impact of tinnitus and promote well-being are increased, such as relaxation techniques.

We also set goals to help patients. Goals can be used as behavioural experiments to test the validity of assumptions and fears about tinnitus. Goals must be carefully chosen so that they are attainable and measurable. Often these experiments are carried out at the same time as detailed cognitive monitoring, as unhelpful patterns of thinking can undermine progress. Setbacks are seen as useful opportunities for learning to cope with occasional increases in tinnitus.

In addition to the benefits of being able to live life as before, a powerful consequence of successful behavioural experiments can be the return of a sense of control. As confidence grows, the patient can stop fearing tinnitus and indeed feel they can tolerate it. Therefore, the natural response of habituation will be accelerated.

The cornerstone of effective CBT is assessing problems accurately, their relationship to one another and what is causing them. Effective therapies are developed in collaboration with the patient on the basis of a detailed consideration of his/her unique circumstances. We use CBT successfully alongside the work of our colleagues in hearing therapy and audiology. It is suitable for early intervention, crisis management and chronic problems associated with tinnitus.

By Danuta Orlowska and David Scott, Clinical Psychologists, Royal National Throat Nose & Ear Hospital, London.

Your GP can assess whether CBT could help you and whether your local NHS offers it.

RNID, the largest charity representing the nine million deaf and hard of hearing people in the UK, and Action for Tinnitus Research (ATR) are aiming to raise awareness of tinnitus on Tinnitus Awareness Day, which this year takes place on Tuesday 22nd March.

More Info can be found at: www.rnid.org.uk

From 50Connect.co.uk