Will CBT work for me?
This is such a frequently asked question
“Will CBT work for me?” is such a frequently asked question. And perfectly understandably so too. There are many types of therapy, and here are just a few of them that immediately spring to mind: psychodynamic therapy, interpersonal therapy, humanistic, existential psychotherapy, dialectical psychotherapy.
Of course, the one we are discussing here – cognitive behaviour therapy (CBT) - is one of the most widely recognised by name by the public at large, and one of the most commonly used psychotherapies in the last 20+ plus years. In the UK, CBT became widely heard about by the public in general probably because of its widespread adoption within the NHS. And there are literally thousands of books about CBT – including self-help books but also tomes for professional therapists – that are available. I haven’t counted the number of CBT books that are in my personal library, but at a guess, I must have in the region of at least 50-60 of them purchased over the past 20 years or so!
Why therapy anyway – be it CBT or other type?
Something I’d really like to briefly address before I discuss anything more about CBT here, is the idea that a psychological therapy was proposed to be helpful for tinnitus in the first place!
Definition of tinnitus (Tinnitus UK):
“[Tinnitus] is the sensation of hearing a sound when there is no external source for that sound. Someone with tinnitus may hear ringing, buzzing, hissing, whistling or other noises. Tinnitus can be there all the time or come and go. The volume of someone’s tinnitus can vary from one episode to the next.”
So, having tinnitus is a physical experience – no different to any other physical experience, from having a headache to having a broken leg.
However, what can and does happen for so many people (around 15% of the 1 in 7 people that “have tinnitus”), is they become overwhelmed by the experience of tinnitus to a point of being really distressed by it.
Were a person become overwhelmed by a headache – there’s an antidote: they can take analgesics that at least gives them some respite from the headache, or may get rid of the headache altogether. It’s similar with a broken leg – extreme pain yes, but painkiller medications help, plus eventually, the broken leg heals.
There is no such antidote to very distressing tinnitus; there is no antidote to tinnitus (that in itself is a huge cause of frustration for many); however, there IS an “antidote to the distress reaction” by learning to replace the distress reaction to tinnitus with a neutral reaction to tinnitus.
Not all “CBT” is the same
Anyone not in the psychotherapy field can be forgiven for assuming that “CBT is CBT”; that all CBT therapists use the same practices as each other, so when choosing a therapist to work with, the only difference would be whether or not you feel comfortable with the individual therapist.
In fact, “CBT” has become an umbrella term for many different forms of psychological therapies, and each of those different types of therapy that fall within the CBT umbrella are specialities in and of themselves, where therapists specialise in one or more of the Cognitive Behavioural therapies.
So, in fact, ALL CBT IS NOT THE SAME, and most certainly, every CBT therapist does not work in the same way, using the same “tools” as every other CBT therapist, for every different issue that every different person undertaking therapy is seeking help to address. There is a wide range of cognitive behavioural therapies, and therapists train extensively in their particular area of specialism and interest. The clinical areas that are well covered in the formal training of CBT therapists are those that present the most widely across the population, so these are predominantly depression and the multiple types and forms of anxiety.
What this ultimately means for patients is they can look for and usually find a suitable therapist to help them if they need help for depression or anxiety.
Unfortunately, this is not the case when you are a patient seeking help for distressing tinnitus!
A couple of baffling examples
Over the years, I have worked with many thousands of patients who have found themselves in the dire situation of experiencing tinnitus that causes them significant distress. Some of them have done some research, learned that CBT is the recommended treatment, have looked in their locality for a CBT therapist, started working with the therapist, only to discover that their tinnitus doesn’t improve, and in numerous if not most cases, felt worse than they did before they began what they believed to be “CBT”!
By the time they find me, their understandable opinion is that “CBT doesn’t work for me”.
When this happens – and it continues to happen on occasion unfortunately – I always ask them the same question: “Can you describe to me what the therapist has been asking you to do?”
It has been happening for years – I have been a Hearing Therapist working with tinnitus patients for 30 years, and specialised using CBT for tinnitus distress since I qualified in psychotherapy in 2005. Their descriptions have never ceased to astound, and even shock me!
Example 1: A recent example from someone enrolled in CBT4T is in a lady’s Mini-history who’s CBT therapist (apparently a specialist in OCD) advised her - and I quote:
“I was given advice to try and go towards the head sensations (tinnitus and head pressure) and make them worse as an exposure to not be worried by it. I was told not to try and relax, to do things like spinning in a chair to make them worse etc.”
This was probably one of the most shocking examples I have ever heard of!
And although example 2 might be less worrying overall, I have always failed to see the point of it:
Example 2: However, here is a much more common example I have seen so many times over the years. A patient with distressing tinnitus has gone to a CBT therapist who tells them to visit their local supermarket several times per week, instructing them to stay there longer on each visit, no matter how loud/intrusive the tinnitus becomes.
This second example I find baffling and yet I have had multiple patients report to me they have been instructed to do it. It is another example of “Exposure Therapy” – but the commonly used “supermarket” (a busy place with lots of people) exercise used supposedly to help with social anxiety.
What is profoundly obvious from these examples – and others that I have been told of over the years – is there are CBT therapists working at best ineffectively for patients with distressing tinnitus.
A quick internet search: “Will CBT work for me”
I haven’t spent hours researching this, but very near the top of the search came: https://www.psychologytoday.com/us/blog/true-self-empowerment/202301/why-cbt-might-not-be-working-for-you
It gives a clear outline of what “CBT” is intended to do, and its limitations.
The “Will CBT work for me” question and how I can best answer that question in relation to CBT4T
If you are a human being born on the planet Earth – this ensures your physiology is the same as any other human being – and you follow the CBT4T process, yes it will work for you! All you need to do is follow the process. Oh yes – and the course is currently only available in English! People from all walks of life have used the programme, so you don’t need a doctorate in philosophy either!
There is plenty of Users’ Feedback on the website – including their quantitative clinical Outcomes.
The process employed in CBT4T has been specifically developed (by Debbie Featherstone) for people with tinnitus who are highly distressed by it. So, the process within CBT4T has not been copied from elsewhere. There is one piece of work included in the CBT part of the CBT4T process that is the work of another therapist, and that is the Core Belief work in the latter stages (Element 3) of the CBT4T process, where Christine Padesky’s Core Belief work is included and referenced in full.
Even more significantly, the CBT4T process is NOT LIMITED TO CBT. The process is informed by and from 30+ years of Hearing Therapy and Psychotherapy clinical practice:
Knowledge and understanding of tinnitus and hearing
Relevant areas of neuroscience: neurobiology, neurochemistry, neuroplasticity
Polyvagal theory including the Autonomic Ladder
Consciousness studies
These four are in addition to the bespoke CBT, carefully combined and woven in to a Four Part (Four Elements) multiple staged process to be used by each individual AT A PACE that suits their own individual needs and requirements.
CBT4T is not an academic exercise where as long as you read each section, you’ll “get it” and as if by magic, changes come about! Were there to be such a means of changing human physiology including neurophysiology, I’m sure it would be great, and we’d all welcome it!
Like the rest of CBT4T, the practical “doing” aspects of the process are woven in to and throughout the process. And practices begin at Element 1: Stage 1. The easiest way of describing this is for you to go to the CBT4T Supplement. Where you are already enrolled on the course, you will already be familiar with the breath work and physiological relaxation practices, building a new daily routine of activities from the outset including the logs.
Some additional links that may be of interest
To view the CBT4T full programme Outline: https://courses.tinnituseprogram.org/cbt4t-2025
To view CBT for Tinnitus Distress for Audiologists, Hearing Therapists (soon to be updated) https://courses.tinnituseprogram.org/cbt-for-tinnitus-distress
To view CBT for Tinnitus for Advisors & Support Workers (soon to be updated) https://courses.tinnituseprogram.org/tinnitus-advisors