Tinnitus and Cognitive Behavioral Therapy
What Is Tinnitus?
Tinnitus is the perception of sound — often described as ringing, buzzing, or humming — that isn't coming from any outside source (Aazh et al., 2019). While tinnitus is linked to hearing loss in up to 43.2% of cases (Oosterloo et al., 2021), most of the time its exact cause isn't known (Zenner et al., 2013).
It's also a common experience. Between 9% and 40% of people in the United States report having tinnitus symptoms at some point in their lives (Oosterloo et al., 2021). Most people manage fine day-to-day, but an estimated 5–20% experience symptoms severe enough to significantly disrupt daily life (Oosterloo et al., 2021).
Research also shows a connection between tinnitus and mental health, including anxiety, sleep problems, depression, irritability, excessive worry, and general distress. Interestingly, these emotional effects can show up even in people whose tinnitus isn't otherwise interfering with their daily functioning (Oosterloo et al., 2021).
Is There a Cure or Treatment for Tinnitus?
There's currently no known cure for chronic tinnitus, but it can be effectively managed (Manchaiah et al., 2020). Treatment options include working with an audiologist, medical approaches such as medication, and psychological interventions.
One well-supported option is Cognitive Behavioral Therapy (CBT), a form of psychotherapy that has been shown to help people manage both the emotional and practical impact of tinnitus, including the annoyance and distress it can cause (Manchaiah et al., 2020; Andersson, 2002; Hoare et al., 2011; Hesser et al., 2011). CBT is also a well-established treatment for anxiety, depression, and insomnia — conditions that often occur alongside tinnitus (Andersson, 2002).
What Is CBT?
Cognitive Behavioral Therapy (CBT) is a type of psychotherapy that combines cognitive and behavioral techniques. It was developed by Dr. Aaron Beck and has since become one of the most extensively researched approaches for treating a wide range of mental health concerns.
At its core, CBT is based on the idea that our thoughts, feelings, and behaviors all influence one another. When something happens — whether it's an outside event, like a conversation, or an internal one, like a thought or feeling — it's often our interpretation of that event, not the event itself, that shapes how we respond. CBT theory suggests that unhelpful or inaccurate belief patterns can lead to distress and can color the way we see ourselves, the future, and the world around us.
In CBT, a client and therapist work together to build practical skills for managing difficult thoughts, feelings, and urges. Along the way, clients gain a clearer understanding of their own thinking patterns, which helps them respond to life's challenges in healthier ways. Over time, this tends to reduce psychological distress and unhelpful behavior patterns (Beck, 2011).
CBT is typically time-limited, and treatment is collaborative — clients and therapists set goals together, and the work stays focused on present-day problems rather than deep exploration of the past (Beck, 2011). The specific techniques used depend on each client's individual needs. Homework between sessions is also a common part of CBT, giving clients a chance to practice new skills in real life.
Is CBT One of the Most Effective Treatments for Tinnitus?
Yes — CBT is one of the most well-researched treatments for tinnitus, supported by a number of controlled studies (Andersson, 2002). It's worth noting that CBT doesn't reduce the actual volume or presence of tinnitus sound, but it has been shown to meaningfully reduce the annoyance and distress that come with it (Andersson, 2002).
One study found that people who completed CBT for tinnitus continued to show greater tolerance of their symptoms and less annoyance even after treatment ended (Andersson et al., 2001). Another found that CBT tailored specifically to tinnitus was an effective treatment for people with chronic symptoms (Zenner et al., 2013). A broader review of tinnitus management strategies also concluded that therapist-delivered CBT is an effective option based on the current evidence (Hoare et al., 2011).
How Long Does CBT Treatment for Tinnitus Take?
The length of treatment varies depending on each person's symptoms. In general, CBT for tinnitus is a short-term treatment — one study found meaningful improvement in as few as 6 to 10 sessions (Andersson et al., 2001).
If tinnitus occurs alongside another condition, such as anxiety, depression, or insomnia, treatment may take longer, since therapy will address both tinnitus and the co-occurring symptoms. The good news is that research suggests improvements made during CBT tend to last well beyond the end of treatment (Andersson, 2002; Andersson et al., 2001). Your therapist will work with you to determine the right length of treatment and will check in regularly to adjust the approach as needed.
How Can I Find a CBT Therapist?
Getting started can feel overwhelming, but the right resources can make it easier. Websites like Psychology Today's therapist directory let you search by zip code and filter results by factors like location, price, insurance, and gender. When searching for a tinnitus-specific therapist, look for practitioners who list "Cognitive Behavioral (CBT)" as one of their specialties.
You can also find referrals through your primary care physician, your school (if applicable), or a general internet search. If a therapist you speak with doesn't feel like the right fit, many are happy to point you toward other providers who might be. Fit matters — a good working relationship between client and therapist plays a real role in how well therapy works, and many therapists offer a free initial consultation to help you figure out if they're the right match.
References
Aazh, H., Bryant, C., & Moore, B. (2019). Patients' perspectives about the acceptability and effectiveness of audiologist-delivered cognitive behavioral therapy for tinnitus and/or hyperacusis rehabilitation. American Journal of Audiology, 28(4), 973–985. https://doi.org/10.1044/2019_AJA-19-0045
Andersson, G. (2002). Psychological aspects of tinnitus and the application of cognitive-behavioral therapy. Clinical Psychology Review, 22(7), 977–990. https://doi.org/10.1016/s0272-7358(01)00124-6
Andersson, G., Vretblad, P., Larsen, H. C., & Lyttkens, L. (2001). Longitudinal follow-up of tinnitus complaints. Archives of Otolaryngology–Head & Neck Surgery, 127(2), 175–179. https://doi.org/10.1001/archotol.127.2.175
Beck, J. S. (2011). Cognitive therapy: Basics and beyond (2nd ed.). Guilford Press.
Hesser, H., Weise, C., Westin, V. Z., & Andersson, G. (2011). A systematic review and meta-analysis of randomized controlled trials of cognitive-behavioral therapy for tinnitus distress. Clinical Psychology Review, 31(4), 545–553. https://doi.org/10.1016/j.cpr.2010.12.006
Hoare, D. J., Kowalkowski, V. L., Kang, S., & Hall, D. A. (2011). Systematic review and meta-analyses of randomized controlled trials examining tinnitus management. The Laryngoscope, 121(7), 1555–1564. https://doi.org/10.1002/lary.21825
Manchaiah, V., Vlaescu, G., Varadaraj, S., Aronson, E. P., Fagelson, M. A., Munoz, M. F., Andersson, G., & Beukes, E. W. (2020). Features, functionality, and acceptability of internet-based cognitive behavioral therapy for tinnitus in the United States. American Journal of Audiology, 29(3), 476–490. https://doi.org/10.1044/2020_AJA-20-00002
Oosterloo, B. C., de Feijter, M., Croll, P. H., Baatenburg de Jong, R. J., Luik, A. I., & Goedegebure, A. (2021). Cross-sectional and longitudinal associations between tinnitus and mental health in a population-based sample of middle-aged and elderly persons. JAMA Otolaryngology–Head & Neck Surgery, 147(8), 708–716. https://doi.org/10.1001/jamaoto.2021.1049
Zenner, H. P., Vonthein, R., Zenner, B., Leuchtweis, R., Plontke, S. K., Torka, W., Pogge, S., & Birbaumer, N. (2013). Standardized tinnitus-specific individual cognitive-behavioral therapy: A controlled outcome study with 286 tinnitus patients. Hearing Research, 298, 117–125. https://doi.org/10.1016/j.heares.2012.11.013