Cognitive behavioral therapy (CBT) for tinnitus may sound unusual, especially since CBT is a model of therapy often used to treat mental health disorders. But it can help improve your quality of life when living with Tinnitus.

Tinnitus isn’t dangerous, but it can be distressing, and that’s where cognitive behavioral therapy (CBT) comes in.

CBT is a framework of therapy that works to restructure your thought processes. While it’s primarily used in association with mental health conditions, these aren’t the only conditions that can cause psychological distress.

Because of how intrusive tinnitus can be and how some cases can’t be cured, it’s often a significant source of negative thoughts and emotions.

Tinnitus is an auditory condition, meaning it affects your hearing perception.

It’s often described as a buzzing, whistling, or ringing that only you can hear. For some people, tinnitus is constant, while for others, it comes and goes.

Tinnitus doesn’t come from an external source of sound. While the pathophysiology isn’t well understood, many experts believe that damage to the inner ear distorts the sensory sound input interpreted by the brain.

This results in the perception of phantom sounds — sounds that only you can hear.

Chronic ear infections, pressure on the cranial nerve, hearing loss, and loud noise exposure are all potential underlying causes of tinnitus.

When other people can hear tinnitus

There’s a form of tinnitus that is associated with your heartbeat called objective tinnitus. In this condition, a vascular disorder can generate sounds that can be heard through a stethoscope.

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Tinnitus symptoms can vary from person to person. The only universal symptom is the presence of sound without external stimuli.

Sound variations include:

  • coming from the ear, ears, or head
  • buzzing, ringing, humming, clicking, whistling, hissing, or squealing
  • soft or loud tone
  • high or low pitch
  • changing with body position
  • rhythmic (often in time with your pulse)

CBT is an established treatment approach for tinnitus, but large-scale research is lacking due to the subjective nature of this condition.

A systematic review from 2020 reaffirmed previous findings that it was an effective therapy for tinnitus, with in-person sessions making statistically significant improvements across areas of health-related quality of life, depression, and anxiety.

A 28-study Cochrane review from 2020 also concluded that CBT may be effective in reducing tinnitus’s negative effect on quality of life. However, the review authors noted that more research is necessary.

How does cognitive behavioral therapy for tinnitus work?

CBT doesn’t eliminate what you’re hearing or how intensely you’re hearing it, but it may help you change how you respond to tinnitus in everyday life.

The psychological distress around tinnitus is what clinically defines its severity. How you react to this condition emotionally and how well you cope determines whether you view tinnitus as insignificant or as a burden.

CBT is used to modify unhelpful thought and behavior patterns related to this condition. Its goals are to teach:

  • Careful thinking (cognitive restructuring): Viewing tinnitus factually and avoiding worse-case-scenario thoughts.
  • Mindfulness: Accepting unwanted realities like tinnitus and separating them from emotions.
  • Therapeutic sound: Using background sound to help reduce the perception of tinnitus.
  • Courageous action: Taking steps to live life as you would without tinnitus.

By focusing on these things, CBT shifts your tinnitus response from stressful to neutral. This nonreactive state is known as habituation — when you’re accustomed to tinnitus and barely notice it.

In other words, if you can train yourself to view tinnitus as unimportant, your emotions and behaviors should mirror that mindset.

CBT is a complex process, but it often involves simple steps toward changing how you think and react.

Thought record

A thought record helps you identify when your thoughts and emotions about tinnitus are not factual or logical. This exercise involves writing down the scenario you have in your head, noting your immediate response, and considering what reasonable alternative thoughts would be.

For example, if you’re watching a movie and tinnitus is distracting you, your first thought may be, “I’ll never adapt to tinnitus.” An alternative, reasonable thought would be, “This is frustrating now, but I can learn to adapt to tinnitus.”

Acceptance and change chart

The acceptance and change chart works on accepting tinnitus as a part of life and not a profound hardship.

The chart consists of four sections:

  • the problem
  • change (Can it be changed? How?)
  • accept (Is it permanent?)
  • accept for now (Is it something that can’t be changed now but will get better?)

It can help you take an inventory of the things that can’t be changed about tinnitus and can help you focus on the things you can improve.

Self-coaching

Self-coaching can be as simple as having a mantra that you say to yourself to reinforce positive thinking.

An example could be: “Most people habituate to tinnitus. I can do this. I will not let tinnitus rule my life.”

Relaxation strategies

It takes time to switch off your distress response to tinnitus. You’re training your body to let go of knee-jerk negative emotions, and relaxation methods can help you do that.

When you need to break free from negative thoughts, you can try:

Masking

You can’t change tinnitus, but you can control what else you’re hearing.

Masking works by making your brain work double-time to help distract you from your tinnitus symptoms. Try focusing on a background sound in addition to tinnitus until the two blend together and tinnitus isn’t as noticeable.

Both CBT and tinnitus retraining therapy (TRT) have the goal of creating habituation, and both are also backed by limited research.

TRT involves counseling, but it isn’t a whole-health approach like CBT. TRT works off the neurophysiological model of tinnitus. It uses counseling to educate you about the brain and why you’re experiencing phantom sounds, and through this knowledge, your anxiety and distress about tinnitus may improve.

TRT then uses targeted sound therapy to desensitize you to tinnitus.

According to the American Tinnitus Association, CBT has the strongest scientific evidence of the two treatment approaches, but TRT may still be effective for many people.

The Cochrane review compared CBT to TRT and noted CBT may be slightly better than TRT when it comes to overall quality of life improvement.

Cognitive behavioral therapy for tinnitus is a therapeutic model intended to improve quality of life through habituation, cognitive restructuring, and the development of coping skills.

Although research is limited on treatment for tinnitus, CBT is widely accepted as a viable treatment option.