Arizona's Premier Tinnitus & Hearing Center

Tinnitus and Hearing Center of Arizona - Audiology, Tinnitus, Oticon, Phonak, Resound Hearing Aids Tempe. Formerly Tri-City Audiology Tempe.

About Cognitive Behavior Therapy for Tinnitus


Clinical management of tinnitus should follow evidence-based guidelines. The highest standard for providing such evidence comes from randomized-controlled trials (RCT's) that are properly conducted and reported. Evidence-based guidelines for the clinical management of tinnitus did not exist until recently. The American Academy of Otolaryngology-Head and Neck Surgery Foundation has released the first ever multi-disciplinary, evidence-based clinical practice guidelines to improve the diagnosis and management of tinnitus. See http://oto.sagepub.com/content/151/2_suppl/S1.full.pdf+html. Under Statement 9 - Cognitive Behavioral Therapy (CBT), it states that clinicians should recommend CBT to patients with persistent, bothersome tinnitus. The guidelines further state that sound therapy may be another reasonable management option to offer patients only when appropriate counseling is provided by the clinician. A comprehensive review of the literature surrounding Cognitive Therapy treatments for tinnitus was conducted in 2014. Results confirmed that CBT interventions for the management of tinnitus symptoms is the most evidence-based treatment option so far. See http://www.audiology.org/news/cognitive-behavioral-therapy-and-tinnitus

What Is Cognitive Behavior Therapy (CBT)?

CBT has been scientifically tested and found to be effective in over three hundred clinical trials for many different disorders. CBT is more focused on the present, more time-limited, and more problem-solving oriented. Much of what the patient does is solve current problems. In addition, patients learn specific skills that they can use for the rest of their lives. These skills involve identifying distorted thinking, modifying beliefs, relating to others in different ways, and changing behaviors.

The Theory Behind CBT

CBT is based on the cognitive model, which is, simply that the way we perceive situations influences how we feel emotionally. The cognitive model describes how people's perceptions of, or spontaneous thoughts about, situations influence their emotional, behavioral (and often physiological) reactions. Individuals' perceptions are often distorted and dysfunctional when they are distressed. They can learn to identify and evaluate their "automatic thoughts", and to correct their thinking so that it more closely resembles reality. When they do so, their distress usually decreases, they are able to behave more functionally, and their physiological arousal goes away.

Individuals also learn to identify and modify their distorted beliefs: their basic understanding of themselves, their worlds, and other people. These distorted beliefs influence their processing of information and lead to their distorted thoughts. The cognitive model explains individuals' emotional, physiological, and behavioral responses brought about by their perceptions of experience, which are influenced by their beliefs and by their characteristic ways of interacting with the world, as well as by the experiences themselves. A gentle Socratic questioning process can help patients evaluate and respond to their automatic thoughts and beliefs. When patients think more realistically, they feel better. The emphasis is also consistently on solving problems and initiating behavioral change.

Cognitive Behavior Therapy Example

We commonly believe that how we feel is determined by the severity of the problems we face. For instance, if you have a stomach ache, you feel bad. But if you have a ruptured appendix, you feel worse. This concept holds true in cases where the pain pathways are activated. However, in conditions that do not involve physical pain (and even in some conditions that do), how we feel is primarily determined not by the severity of our problems, but rather by our thoughts about our problems, no matter how severe. In the stressed, distressed, or depressed individual those thoughts are often irrational and based in emotion rather than based in logic. Cognitive behavioral therapists refer to such irrational emotion-based thoughts as cognitive distortions. Carrying this a bit further, it follows that distorted thoughts lead to distorted feelings and ultimately to distorted physical manifestations of those distorted feelings.
An example adapted from a story originally related by cognitive behavioral therapist Dr. Laurence McKenna at a 1998 tinnitus seminar in Nottingham, UK: Fred gets into a subway train that is overflowing with passengers. A man starts poking him in the back with an umbrella for no reason at all. Fred gets angry, his pulse quickens, his blood pressure rises, and his face turns red. But when he turns around to tell the man to stop poking him in the back, Fred sees that the man isn't carrying an umbrella. He's carrying a gun. What happens now? Fred's face turns pale, his palms grow moist, and his mouth becomes dry. He reaches into his pocket to hand over his wallet, but when he turns around again, Fred discovers that the would-be robber isn't carrying a gun after all. It's a blind man with a cane who is struggling to find a safe location in the moving train. The color returns to Fred's face, his pulse slows, and his blood pressure normalizes... as he assists the man to a nearby seat. So, what happened here? Within two or three minutes, Fred has felt anger, then fear, and then compassion - along with the measurable and observable physical changes generated by these three powerful emotions - all because of his thoughts about a few pokes in his back. As we can see from this story, how our passenger feels after being poked in the back is greatly influenced by how he thinks about it. Now severe tinnitus is certainly a far different and much more complex problem than a mere poke in the back. The rule, however, remains the same: Regardless of how loud or high-pitched your tinnitus might be, how your tinnitus makes you feel is largely determined by your thoughts about it. For any given level of tinnitus severity, whatever steps you can take to minimize or eliminate irrational emotion-based thinking, the better you will feel and consequently the better off you will be.
Often underappreciated within the medical community, cognitive behavioral therapy is one of the most powerful weapons in the tinnitus clinician's arsenal. Will it cure your tinnitus? No. But it will help even those with incredibly severe tinnitus return to a meaningful, productive, and truly enjoyable life, which for many is indeed a powerful accomplishment.

Getting Started

I have and continue to receive extensive training in Cognitive Behavior Therapy (CBT) from The Beck Institute in Philadelphia, PA. I offer an intensive eight session program designed to systematically train you how to desensitize your nervous system and manage your symptoms in a highly effective manner: Cognitive Behavioral Interventions for Tinnitus & Misophonia - The Rohe Methodâ„¢ is symptom management that provides you with real tools and a comprehensive step-by-step approach to promote enduring relief. This is not psychotherapy as I am not a psychologist. I borrowed from the principles of CBT to create a program that targets specific areas of your brain that promotes rewiring and retraining through a systematic approach. The techniques and procedures I use are evidence-based and supported through rigorous clinical research. It takes dedicated work, but I am here to guide you every step of the way. If you have tried TRT or some other treatment option and haven't improved or feel stuck, don't give up. Call to schedule your appointment today at (480) 831-6159.

Find a Certified Cognitive Therapist in Your Area

Visit the Academy of Cognitive Therapy (ACT) website: www.academyofct.org

You can contact the Academy of Cognitive Therapy directly at:

Academy of Cognitive Therapy

245 N. 15th Street, MS 403

17 New College Building

Department of Psychiatry

Philadelphia, PA 19102

Phone: 215.831.7838

Fax: 215.537.1789

E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.


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