Why CBT for Tinnitus, Stress and Anxiety?

CBT (Cognitive Behaviour Therapy) is acknowledged to be the only clinical intervention with a strong evidence-base for reducing tinnitus distress. The CBT for Tinnitus E-Programme (CBT4T) does this through enabling you to lower and ultimately remove emotional reaction to tinnitus. When there is a discomforting level of emotional reaction to tinnitus - rather than a neutral response - CBT4T gives you the tools to bring about an increasingly neutral response that leads to noticing tinnitus less and less.

However, when a person is already disposed to being anxious and/or stressed - and according to the ONS around 40% of the UK population are recorded as having anxiety - any anxiety existing pre-tinnitus is not going to spontaneously reduce and could, in fact, increase in reaction to tinnitus. I can report I have observed this to be the case over many years of clinical practice. Such issues are psychologically complex anyway, as anxiety surfaces in different guises. Generalised anxiety is the most common type of anxiety diagnosed, but there are others, for example health anxiety, social anxiety, OCD to name but three. Of all types of anxiety, GAD and health anxiety are the most frequently mentioned by those enrolling in the CBT4T programme. The CBT4T process is able to cater for their needs and, of course, they have support from Debbie Featherstone, a qualified and experienced psychotherapist in addition to being a Hearing Therapist.

The CBT concept used in CBT4T (CBT for Tinnitus E-Programme) can be relatable to familiar experiences: for example, say someone says or does something hurtful to you. If that person matters to you, you’ll keep thinking about what they said or did, and get upset over it repeatedly. It can take a long time to not care what they said or did; and when you persist in wondering why they would say or do such a horrible thing, or maybe you hold a grudge and feel angry because they hurt you so badly, you’ll keep returning to it in your thoughts and continue to feel hurt and upset. Maybe as the months and years pass, the hurt might reduce and you do think of it less often, but it will still hurt.

On the other hand, if the person doesn’t matter to you – or you find a way of making them matter less to you (which we all have happen during our life sometimes) – you find you yourself thinking about what they did less and less relatively quickly, until it rarely comes to mind. Even when it does come to mind, you have a more neutral (less emotional) attitude toward it - it hurts much less, if at all. This example reflects the same principle behind the Neuroscience & CBT Process used in CBT4T.

Understand more about Cognitive Behaviour Therapy (CBT) for tinnitus in CBT4T

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".

CBT4T is a process created for those with very significant "tinnitus distress". Complete a Tinnitus Functional Index to identify suitability.

Outcomes for the CBT for Tinnitus E-Programme and reviews demonstrate effectiveness.

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 CBT4T 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

How is CBT used in CBT4T?

For when tinnitus is a 'big problem' or 'very big problem' reflected in the Tinnitus Functional Index (TFI) as Category 4 or 5

CBT4T uses a combined Neuroscience & CBT process developed by Debbie Featherstone specifically 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 process in CBT4T: 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 psychology and counselling practitioners
Since 2018, psychological flexibility and 3rd wave CBT models and practices are increasingly incorporated in to CBT4T, including some from Acceptance & Commitment Therapy (ACT) and Dialectical Behaviour Therapy (DBT) 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 CBT4T 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. To do this, you'll use bespoke "tools" that DISRUPT old, unhelpful embedded neural pathways > GROW NEW pathways > STRENGTHEN the new pathways
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 CBT4T programme, such use diminishes spontaneously without a need to ban its use
To be as effective as it is, CBT4T cannot and is not limited to CBT; on the contrary, CBT4T draws on the latest, up to date relevant research and expertise from other fields including trauma, neuroscience, and consciousness studies
CBT4T uses predominantly bespoke "CBT tools" developed by Debbie Featherstone, specifically for the CBT4T programme
The expectation is that everyone who completes this process as it is set out - even those starting with a TFI category 5 (73-100% - tinnitus is a very big problem) - reaches at least TFI category 2 (18-31% - tinnitus is a small problem), See Outcomes

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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