Cognitive Behaviour Therapy (CBT) and use of hearing aids are the only treatments considered to have efficacy and be safe to use for tinnitus (see Tinnitus UK website section on treatments). In the UK, CBT including digital tinnitus-related CBT, provided by psychologists is also a treatment recommended by NICE (National Institute for Health & Care Excellence) last published in March 2020, .

For anyone seeking CBT to reduce distress when it accompanies their tinnitus, it soon becomes apparent that finding such help is extremely difficult. Psychology-trained clinicians qualified to undertake the work are very few indeed, certainly here in the UK. Even as a UK Hearing Therapist with responsibility for tinnitus patients in the NHS, I undertook 5 years of additional training: a PGDip Psychotherapy followed by MSc Psychotherapy, to be able to competently and safely provide treatment, including CBT.

Cognitive Behaviour Therapy (CBT) is NOT a single methodology, though all too often, the unwitting patient seeking out CBT can be forgiven for mistaking it as such. There are so many books for example, with bold simplistic titles saying "CBT for X", as though there is only one form of "CBT for X".

On the contrary, CBT is a wide-ranging group of psychotherapies, sometimes referred to as a “family of therapies”, and like most families, they don’t all agree with one another! As such, some lend themselves more appropriately to specific presenting issues than others. Tinnitus distress is a specific presenting issue but it invariably includes other issues too. Depending on how the tinnitus impacts an individual person, additional co-existing presenting issues also must be addressed because of their impact on the tinnitus distress. Any CBT used for tinnitus distress therefore has to be appropriate, and delivered by someone qualified to deliver it responsibly, in a safe way.

As clinicians, we must always adhere to biomedical ethics, including but not limited to the primary ethic: Non-Maleficence. The principle of non-maleficence – do no harm – asserts that a health care professional should act in such a way that he or she does no harm, even if her or his patient or client requests this (Ref: Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 6th Ed. New York: Oxford University Press; 2009)

Take the CBT for Tinnitus E-Programme for example. I have lost count of the number of updates my course has had! It started out in 2009 not as CBT, but as a programme of tinnitus management with a cognitive approach. Although I’d been a qualified Hearing Therapist working with patients with distressing tinnitus since 1994, and a qualified Psychotherapist since 2005, I was still learning how best to apply Cognitive Behaviour Therapy with patients.

There were additions and updates made between 2009-2018, but it wasn’t until 2018 I was sufficiently confident to change it to CBT for Tinnitus E-Programme. I have consistently referred to the programme as a process, and a process that is unique. It was natural to me to describe it as such, being aware of the considerable range of Cognitive Behaviour Therapies there are. I developed new CBT tools that were more suited to purpose, having moved away from much of 2nd wave CBT (restructuring of negative thoughts to bring about emotion and feelings changes) because too many patients found it difficult to use.

Even now in 2023, I am adding helpful, bespoke tools to help aid and complement learning. It’s also true to say the course is not limited to CBT alone; it includes relevant research and expertise from other fields including neuroscience, trauma, and consciousness.

The CBT for Tinnitus E-Programme also includes 1-1 support. This is essential in my professional opinion, and I know those using the course value that support because they tell me so! For most, two 1-1 appointments are enough, especially as there is also email support when it’s needed. It’s the 1-1 time in particular where my psychotherapy (and Hearing Therapy) experience is enormously important. Each individual person using the course is different. The only thing they have in common is tinnitus - even tinnitus isn’t the same for everyone of course - everything is individual: their individuality as a person, as a husband, wife, partner, mum, dad; how they perceive their role in the family which has often changed since tinnitus onset; how their family is affected, often their role as carer to older parents and grandparents, work, social lives, hobbies and interests… It’s a very long list, and so often there are additional health issues having to be dealt with too, not infrequently very challenging, serious health issues.

Finally, accountability! Anyone qualified (or not, unfortunately!) can make claims that this or that is “what they claim it to be”. Even reviews can be made up by those manipulative enough to do so.

When I first qualified as a Hearing Therapist back in 1994, the role of a Hearing Therapist was not understood by audiologists, and in many departments across the UK, including the one I started out in initially, we were viewed by audiologists as unnecessary and expensive! Our starting pay grade was considerably higher than the starting pay grade for audiologists. It was mostly because of this that many Hearing Therapists were persistently expected to justify their position. Hearing Therapists were so few in number compared to numbers of audiologists, and back then, there was no agreed mechanism through which we were able to justify our positions, so we each had to work out our own means of doing so.

My way was to use Outcome Measures. There weren’t many of those about back in the early-mid nineties, particularly fully-validated measures to use to measure clinical Outcomes. So I used the validated measures that were available, but had to make up my own for the most part!

Fortunately, there is no reason nowadays to have to make them up! Published research massively improved over the years, giving rise to numerous clinical measures being made available. So it’s mostly down to how my role as a Hearing Therapist began all those years ago that led to me using clinical measures for all work I undertake with patients, including those using the CBT for Tinnitus E-Programme. The purpose has changed though. I use them not to justify anything, but to be accountable for my work with patients, and even more than that, measured Outcomes work as an excellent reinforcer for patients when they are able to quantify their progress.