Cognitive Behavioral Therapy for Tinnitus

By Eldré W. Beukes
January 28, 2021

You can spot them in your waiting room, the patient that you know is going to be more challenging than the average. That is the patient with distressing tinnitus. You may have had numerous conversations already and suggested sound enrichment, but for this patient it has not helped. This is the moment you wish you had an extra trick you could pull out of your sleeve, but what? You are not alone finding you have run out of ideas for some patients and just not feeling you are helping them sufficiently. This is the reason for this book, Cognitive Behavioral Therapy for Tinnitus; it will come to your rescue and greatly enhance your tinnitus service provision.

Why Is Tinnitus so Difficult to Manage?

Despite the many advances in medical research, some conditions continue to perplex researchers and clinicians. One such symptom is tinnitus, characterized by the perception of sound in the absence of any external stimuli. Some are not bothered by tinnitus, whereas for others, constantly hearing sound in their ears and/head can be life-changing and debilitating. The sound(s) they hear are constantly there, intruding on any peaceful activity or hope of silence. This may lead to additional functional problems such as insomnia, reduced cognitive performance, and thought processing difficulties (Clarke et al., 2020; Watts et al., 2018). Tinnitus is furthermore associated with an increased risk of psychological difficulties such as anxiety, depression, and reduced quality of life (Salazar et al., 2019; Trevis, McLachlan & Wilson, 2018). As a patient with tinnitus, the journey to help is often long and fruitless. Although many diagnostic tests are often performed, they are still left at the end without an actual treatment or intervention. Even audiologists, who specialize in hearing and tinnitus problems, feel their training is not sufficient to manage distressing tinnitus. Managing tinnitus is notoriously challenging, as tinnitus is so complex. There is often not a straightforward medical cause, or defined treatment and seldomly a simple cure (Zenner et al., 2017).

 ​​​​​​How Can Those with Tinnitus Be Helped?

When it comes to tinnitus management approaches, there are myriad approaches, ranging from medication to alternative therapies to complex sound-based approaches. Due to the relationship between tinnitus and psychological distress, psychological interventions have proved to be most effective in managing tinnitus. The intervention with strongest research evidence is cognitive behavioral therapy (CBT) for tinnitus (Fuller et al., 2020; Landry et al., 2020). CBT is psychological treatment addressing unhelpful thought patterns and emotional reactions caused by tinnitus (Andersson, 2002). Despite the large evidence base, accessibility to CBT for tinnitus is limited as there are not enough health care providers with the knowledge and expertise to provide CBT to this population (Henry et al., 2019).

Expanding the Role of Audiologists

This book is based on an evidence-based CBT intervention for tinnitus, that has been applied in numerous clinical trials during the last three decades. Originally, the intervention was applied by clinical psychologists. Due to limitations surrounding psychological support, providing audiological guidance has been assessed and results have indicated the potential of audiologist to provide such guidance (Beukes et al., 2018). As the materials are largely presented as a self-help guide applying health literacy strategies (i.e., written at 6th grade reading level), this can be used by tinnitus patients themselves to read and learn strategies to cope with tinnitus. In addition, audiologists are able to use the book as a clinical manual so that they can present the materials to their patients in a structured way.

How Does This Book Enhance My Clinical Practice?

To overcome these barriers, we have taken an evidence-based CBT intervention and presented it in this book. It is a practical guide that explains the fundamentals of CBT. It is also a structured management plan, including case-history and assessment guides.  What makes it truly unique is that it provides 22 chapters explaining helpful CBT techniques, and worksheets to monitor their progress. However, the first section (first three chapters) provides understanding of CBT principles to those who do not have any background to this topic.

Is it Helpful for Remote Audiology Sessions due to the COVID-19 Pandemic?

Health care and audiology services are not static and keep evolving due to implementation of evidence-based practice and technological advancements. This book helps outline these advances and how tinnitus services can be run to reduce in-person visits. The structure of the program is ideal for guiding patients through materials that are largely self-help. This guidance can be offered as best suited remotely, such as via email, video calls, or online group session. Regardless of the format, encouraging the patient and guiding them through the strategies can be both helpful to them and rewarding to you as an audiologist. To help with this, we have provided messages you can use to introduce patients to new materials and encourage them while undergoing the intervention. The materials presented in this book have been tested via teleaudiology format on a series of studies across the globe (for review see Beukes et al., 2019).

Cognitive Behavioral Therapy for Tinnitus is a book written to improve patient outcomes, expand the role of audiologists, and help provide accessible, evidence-based tinnitus interventions to those with distressing tinnitus.


Andersson, G. (2002). Psychological aspects of tinnitus and the application of cognitive behavioral therapy. Clinical         Psychology Review, 22(7), 977–990.

 Beukes, E. W., Baguley, D. M., Allen, P. M., Manchaiah, V., & Andersson, G. (2018).  Audiologist-guided Internet-based     cognitive behavior therapy for adults with tinnitus in the United Kingdom: A randomized controlled trial. Ear and   Hearing,  39(3), 423–433. http://doi:10.1097/AUD.0000000000000505

Beukes, E. W., Manchaiah, V., Allen, P. M., Baguley, D. M., & Andersson, G. (2019). Internet-based interventions for adults   with hearing loss, tinnitus, and vestibular disorders: A systematic review and meta-analysis. Trends in Hearing23,   2331216519851749.

 Clarke, N. A., Henshaw, H., Akeroyd, M. A., Adams, B., & Hoare, D. J. (2020). Associations between subjective tinnitus and   cognitive performance: Systematic review and meta-analyses. Trends   in Hearing

Fuller, T., Cima, R., Langguth, B., Mazurek, B., Vlaeyen, J., & Hoare, D. (2020). Cognitive behavioural therapy for   tinnitus.  Cochrane Database of Systematic Reviews. http://doi:10.1002/14651858.CD012614.pub2 

Henry, J., Piskosz, M., Norena, A., & Fournier, P. (2019). Audiologists and tinnitus. American Journal of Audiology, 28(4),   1059–1064.

Landry, E. C., Sandoval, X. C. R., Simeone, C. N., Tidball, G., Lea, J., & Westerberg, B. D. (2020). Systematic review and   network meta-analysis of cognitive and/or behavioral therapies (CBT) for tinnitus. Otology & Neurotology41(2), 153–   166. hppt://doi: 10.1097/MAO.0000000000002472

Salazar, J., Meisel, K., Smith, E., Quiggle, A., McCoy, D., & Amans, M. (2019). Depression in patients with tinnitus: a   systematic review. Otolaryngology, 16, 28–35. http://doi: 10.1177/0194599819835178

Trevis, K., McLachlan, N., & Wlison, S. (2018). A systematic review and meta-analysis of psychological functioning in   chronic tinnitus. Clinical Psychology Review, 60, 62–86. http://doi: 10.1016/j.cpr.2017.12.006

Watts, E. J., Fackrell, K., Smith, S., Sheldrake, J., Haider, H., & Hoare, D. J. (2018). Why is tinnitus a problem? A qualitative   analysis of problems reported by tinnitus patients. Trends in Hearing22,   2331216518812250.

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