CBT4T Substack launched 10th April 2025
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(CBT4T Substack posted 13 May 2025)
Cognitive Behaviour Therapy (CBT) for TinnitusIncludes 1-1 CLINICAL SUPPORTUK based - available in the UK and internationallyExperience improvements in weeksA comprehensive clinical intervention for high distress from tinnitus, anxiety & stressNo 'Tips & Tricks' that don't work long termSuitable for for moderate, severe & very severe tinnitus distressRESULTS MAINTAINED LONG TERM
How much of a problem is your tinnitus? Do you experience anxiety and stress with tinnitus? The CBT for Tinnitus E-Programme (CBT4T) content is online, includes clinical support by email and one to one appointments using Zoom
Reviews: Feedback from Users of CBT4T
Juha (Finland)
Final Review:
Do you recommend others to use the Tinnitus E-Programme and if so, please say why:
"I highly recommend this programme, both as a person with tinnitus and as a Clinical Psychologist and Cognitive Psychotherapist – it provides a first-class ticket to an excellent and effective tinnitus habituation journey!" Go to Juha's full review
Kirk (USA)
Final Review:
Do you recommend others to use the Tinnitus E-Programme and if so, please say why:
"Yes! It works!"
"The Tinnitus E-Programme has been life changing for me. It is very educational and well thought out. I had no idea how connected tinnitus is to the fight or flight reflex, anxiety, etc. The program was easy to follow, included weekly accountability and allows one to progress at their own pace. I’ve completed the program but will be using some of the relaxation and visualization exercises and the other resources for the rest of my life. Excellent program. Amazing results." Go to Kirk's full review
Gary (UK)
Final Review:
Do you recommend others to use the Tinnitus E-Programme and if so, please say why:
"Yes 100%. It really helps you understand tinnitus, what's going on and gives you the tools to take back control over your life."
"I have now completed the course and it was the best decision I could have made. If you're reading this and sceptical about CBT like I was, then don't be. If your willing to engage with the course and the exercises it really does make a difference. My life went from being controlled by tinnitus, to tinnitus no longer having control over me, or my life." Go to Gary's full review
CBT4T - The CBT for Tinnitus E-Programme
"CBT4T is crafted to be an individual process and to be affordable. The CBT4T process has the equivalent effectiveness of 30 hours individual therapy, but for around ONE TENTH of the cost."
The CBT4T process is used AT YOUR OWN PACE. Each stage does have its own MINIMUM length of time set; however, for any process to be robust and consistently produce good outcomes for its users, the process must fit the needs of the individual.
The in-depth content, use of bespoke tools, progress checks, email support and weekly accountability SITREP has reduced the cost by some 90%:
- 30 in-therapy hours (20 x 90 minute sessions) based on £100 per hour* (£100 x 30) = £3,000 : cost of CBT4T enrolment is just £295
- Two one-to-one appointments are already included in your CBT4T 2025 enrolment
- Add-on appointments (commonly 90 minutes) when/if needed are £95.00
- 90% of people enrolling on CBT4T need a maximum two one-to-one appointments already included in enrolment
- All appointments use Zoom
*Private therapy fees vary around the country, and are dependant upon individual therapists' area(s) of specialism. A 60 minute private Consultation is likely to cost anything from £100-£200+
The CBT for Tinnitus E-Programme (CBT4T):
- Uses a neuroscience-informed Cognitive Behaviour Therapy (CBT) Protocol
- Is evidence-based with an excellent track record
- Uses a structured framework that enables you to progress through this bespoke programme at a pace that suits your needs and responsibilities
- Includes highly valued clinical support including email and one-to-one appointments
Is your tinnitus a problem?
- Tinnitus is not a problem (category 1)
- Tinnitus is a small problem (category 2)
- Tinnitus is a moderate problem (category 3)
- Tinnitus is a big problem (category 4)
- Tinnitus is a very big problem (category 5)
Do you experience Anxiety & Stress with Tinnitus?
It is common to experience anxiety and/or stress alongside tinnitus:
- You may have had pre-existing anxiety/stress long before the onset of tinnitus and it seems worse to you because of tinnitus, or
- Anxiety/stress might have become a new additional problem alongside tinnitus
The CBT for Tinnitus E-Programme content is online, includes clinical support with 1-1 appointments
- Work through the structured programme at a pace that suits your needs and your home/work responsibilities
- Combine your learning with 1-1 clinical support
- Clinical support includes use of logs, a weekly SITREP, bespoke CBT tools, email support and one-to-one appointments (using Zoom)
View CBT4T+ Enhanced Support and Enrol
View the course outline including some previewable content. Enhanced Support enrolment has been available since 3 October 2024. It includes a 60-90 minute 1-1 appointment (using Zoom) at the end of each of the first SIX MONTHS of enrolment to review your progress to date and discuss a plan of action for the upcoming month
- Includes a 60-90 minute 1-1 appointment (using Zoom) at the end of each of the first SIX MONTHS of enrolment to review with you your progress to date and discuss a plan of action for the upcoming month
- Enhanced 1-1 support is in addition to logs, email, weekly reporting (SITREP), and bespoke CBT tools
CBT4T is the new name for the CBT for Tinnitus E-Programme from October 2023. It is a 7 stage, 12 part comprehensive clinical intervention combining individual 1-1 support and Internet-based Cognitive Behaviour Therapy (iCBT) as recommended in the UK NICE Guidelines, 2020
The Tinnitus Functional Index (TFI) is a self-report questionnaire measuring severity and impact of tinnitus. Developed by Meikle et al (2012), it is the measure recommended in the UK NICE Guidelines, 2020
The TFI is used when starting CBT4T, repeated at Stage 6 and again at the end of the process
CBT4T is a unique process developed by psychotherapist, CBT specialist & hearing therapist Debbie Featherstone with a 30 year track record - NHS, private practice and since 2009, the Tinnitus E-Programme. The CBT4T course is the latest generation of the CBT for Tinnitus E-Programme for people experiencing distressing tinnitus as well as anxiety and/or stress:
- TINNITUS: Big problem (TFI Category 4: 54-72%) and very big problem (TFI Category 5: 73-100%) | TFI - Tinnitus Functional Index
- STRESS: Moderate-severe (PSS: 14-40) | PSS - Perceived Stress Scale
- ANXIETY: Moderate-severe (GAD-7: 10-21) | GAD-7 - General Anxiety Disorder
- ANXIETY/STRESS SYMPTOMS (ASQ): Moderate (31-60%) | Severe (61-90%) | Extreme (91-100%) | ASQ - Anxiety/Stress Symptoms Questionnaire
The TFI, THI, PSS, GAD-7 & ASQ clinical measures are used to measure your progress through the course. These are completed as you begin the course, repeated at the end of Stage 6 (TFI expected improvement by AT LEAST one category) and at the end of the process when the expected TFI outcome is category 2 (small problem) or category 1 (not a problem). Stress and anxiety outcomes follow suit.
Individuals' TFI outcomes are published alongside their personal feedback/reviews, grouped by their starting TFI category:
Our patients enrolled in CBT4T frequently have hyperacusis (hearing sensitivity) in addition to distressing tinnitus, and hyperacusis is addressed within the course. Some of our enrolees have no pre-tinnitus history of anxiety or stress, but many have a long history of anxiety and/or stress at severe or moderate levels pre and post tinnitus onset. The process in CBT4T addresses both anxiety and stress as well as tinnitus distress.
A further variable is how long our enrolees have been distressed by tinnitus. Enrolees come to the course from across the board: some with recent onset (weeks or a few months); others have struggled for many, many years, while others have had tinnitus for many years, and it has only become problematic more recently.
Variables are not limited to hearing sensitivity, anxiety, stress and the length of time someone has been distressed by tinnitus. They are the most common variables but there have been many more, including for example, co-existing health concerns. In such cases, it is common for the fear and worry of an otherwise unrelated health concern to be significantly impacting tinnitus distress.
The process in the CBT for Tinnitus E-Programme combines 1-1 clinical support via individual appointments using Zoom, email support, logs, Progress Checks as you begin a new Stage, weekly reports (SITREP), bespoke CBT tools and comprehensive, stage-by-stage course content through which you are encouraged to proceed at a pace that suits your individual needs, home and work responsibilities.
We are UK based and the course is provided in English, available in the UK and internationally.
CBT4T
- A uniquely neuroscience-informed CBT process for severe and very severe tinnitus distress
- Employing the Neuroscience & CBT Protocol enables the user to separate having tinnitus from being distressed by tinnitus
- The protocol combines polyvagal informed neuro-psychotherapy and associated neuroscience, behavioural and cognitive therapy with a focus on 3rd wave CBT
- The cognitive therapy used enables psychological flexibility, developing and deepening a recovery-oriented perspective. This is wholly different to 2nd wave CBT that is problem-oriented and thought-focused
- Includes a 6 week course of Autogenic Relaxation Training - a powerful relaxation method
- Enrolment is for one full year | View course
CBT4T
Neuroscience-informed CBT Protocol
Unique
The protocol used in this course has been developed and implemented over time by Debbie Featherstone. The process in CBT4T is UNIQUE. It is designed for those distressed by tinnitus, simultaneously providing a cognitive, behavioural framework that enables users to reduce co-existing symptoms such as: anxiety (general anxiety, social anxiety, health anxiety, panic, trauma), low mood/depressed, sleep problems, whether these are pre-existing to, or since tinnitus onset. With some 30 years clinical, hands-on experience, a Hearing Therapist and qualified Psychotherapist, Debbie draws on her experience to bring a process - tried and tested in an online format since 2009 - as a comprehensive course of neuroscience-informed Cognitive Behaviour Therapy for Tinnitus in to mainstream healthcare
Evidence-based
The course has a strong historical evidence base of effectiveness over 15 years of being used online, including independent evaluation of the original online Tinnitus E-Programme conducted by NIHR NHBRC completed in 2017
Easy to use
Reference to ease of use can be found in the reviews by users of the programme - see Reviews in the menu
Great interaction
Everything from weekly SITREPs, Progress Checks at the start of each new Stage, to the incorporated 1-1 appointments with Debbie, to the logs, interactive bespoke CBT tools and email support
Low Cost - High Value
For such a low cost, you have access to a structured, comprehensive programme of Cognitive Behaviour Therapy tailored specifically to mitigate the experience of tinnitus distress, provided by a fully qualified and highly experienced Hearing Therapy clinician dual qualified in Psychotherapy.
Support
Those using CBT4T (historically known as the CBT for Tinnitus E-Programme) feel genuinely supported throughout the course - see Reviews. You always have email contact, so anything you find concerning, all you need do is send an email and you will ALWAYS receive a reply
Past Users of CBT for Tinnitus E-Programme - A Year On
Long after completing the course, outcomes are maintained and even improved upon. For many years, users were followed up a year and at two years after they complete, as I had done with NHS patients while I was based in Birmingham and in East Lancashire; results were so consistent over such a long period of time, I no longer make those requests. It does happen that some still like to let me know how they are a year on, and even two years on, so when they do, their feedback goes in to the main reviews page
Dean, UK: Initial THI score 98% - final review 22%
A year after Dean completed the CBT for Tinnitus E-Programme, his progress is stable, THI score is 20% and here’s his One Year On review:
“I still carry out daily breathing exercises as my anxiety and stress are triggers. Debbie's counselling always reminds me of the true meaning of tinnitus which helps me on difficult days. My life thanks to Debbie is now much more enjoyable and I cope better with the bad days . I now achieve periods of calm which has benefited me from almost silence at times. Debbie has helped my healing process and I revisit my notes to help me in stressful and anxious periods.” (2020)
Kathy, USA: Initial THI score 68% - final review 20%
A year after Kathy completed the CBT for Tinnitus E-Programme, her progress is stable, THI score is 18% and here's her One Year On review:
"One thing that I have gotten a lot better at is reminding myself that this is not dangerous, there is nothing to fight, that it can't hurt me and that it can just be there in the background without making me upset or afraid. I hardly ever talk about it at all which I think is good. And I am happy to be not dependent on the sound generators any more. I do at times still get frustrated that it isn't completely gone or that it makes it hard at times to relax or makes it hard to hear someone but it is waaaaay less than before. I know that the more I believe it's "no big deal" the better. I do everything I want now and I have benefited from my mantras that all sounds are ok/safe and sounds can't hurt me. I do my breathing daily and am getting regular exercise which I think also helps with sleep and stress. You have helped me SO much." (2019)