CBT for Tinnitus

What it is

CBT is a group of psychological treatments that look at how thinking patterns and the behaviours they drive shape the experience of tinnitus [1]. In trials it ran for 3 to 22 weeks, mostly in hospitals or online [2]. It can be delivered face to face, in a group, or as a therapist-guided internet programme [3].

How it might work

Tinnitus distress is thought to come from a mix of physical and psychological processes, so weakening the psychological side should reduce suffering [1]. This is a proposed explanation.

What the research says

Cochrane review. 28 trials with 2,733 adults who had tinnitus for at least three months. Compared with no treatment or a wait list, CBT may reduce the impact of tinnitus on quality of life (10 trials, 537 people), equal to about 10.9 points lower on the 0-100 Tinnitus Handicap Inventory, where about 7 points is the smallest change that matters [2]. Compared with usual audiological care (3 trials, 444 people), CBT probably lowered the score by a further 5.7 points [2]. Against other active treatments such as relaxation or information, the gap was about 5.8 points [2]. CBT may also slightly reduce depression [2].

Online CBT. In a trial of 124 people with severe tinnitus distress, therapist-guided internet CBT beat a moderated online forum by a large margin on handicap and distress scores, with outcomes tracked for a year [4]. In another trial of 128 adults, internet CBT and face-to-face group CBT both beat a forum, did not differ from each other, and the effects held at 6 months [3]. A 2025 meta-analysis of 37 randomised trials of therapist-supported internet programmes found a large drop in tinnitus distress and a moderate drop in handicap, with smaller gains in depression, anxiety and insomnia [5].

Why it matters beyond the ringing. Tinnitus goes along with depression, anxiety and insomnia in observational studies [6].

Doses used in studies

Programmes lasted 3 to 22 weeks [2]. This is what trials used, not a recommendation.

Safety and interactions

Side effects. Seven trials reported serious adverse effects and CBT probably made little or no difference: six reported none and in one a participant in the CBT group got worse; no other adverse effects were reported [2].

Limits, interactions, pregnancy and other conditions. No data were found on dose limits, medicine interactions, pregnancy or people with other conditions.

Caveats and open questions

The Cochrane review rated the main comparison as low certainty and found no data at 6 or 12 months [2]. A 2020 network meta-analysis found face-to-face CBT clearly beneficial, while guided self-help ranked highest but its pooled effect was not statistically significant [7]. Internet trials had high drop-out and mixed quality [5]. Access to CBT remains hard for many people [1].