Counselling and Cognitive Behavioural Therapy for tinnitus - the same but different: A scoping review

Grant Donald Searchfield^*Dunja VajsakovicBree CampbellCora Swindale

• Audiology, The University of Auckland, Auckland, New Zealand

Background. Tinnitus is a complex experience characterized by sound perception in the absence of an acoustic source, which can accompany or result in psychological distress. Cognitive Behavioral Therapy (CBT) and counselling are two of the most prominent tinnitus therapy methods. CBT is a psychotherapy typically undertaken by psychologists. CBT considers that tinnitus distress results from distorted thinking and resultant maladaptive behaviors. CBT clinicians often employ restructuring techniques to change maladaptive thoughts and behaviors. Tinnitus counselling, commonly in the form of psychoeducation, is frequently used in tinnitus practice by audiologists. Tinnitus counselling aims to reduce the negative impact that tinnitus has on patients’ lives. Counselling uses empathetic conversation and psychoeducation to help people understand their tinnitus and, through demystification, reduce distress. Insufficient availability of psychologist consultations and the strong evidence base for CBT have led to audiologists seeking to practice CBT. Although audiology-led counselling and CBT share some methodologies, the practice of CBT by non-psychologists is controversial. Methods. In this study, we review the literature to determine if therapy outcomes differ between CBT and counseling, various therapy durations, and different therapy providers. From the initial 210 articles chosen based on title relevance, eight studies were selected for data charting. Results. Three studies reported greater efficacy for CBT; in 1 study, counselling was superior, and in four, the outcomes were equivalent. There was a significant amount of variability in content, both between and within the methods used. Studies varied in terms of who provided the therapies and the duration of therapy. Discussion. The literature surveyed is characterized by ambiguity. Both CBT and counselling are helpful, but there is no clear evidence that one is superior to the other. It is also unclear what elements of CBT or counselling contribute the most benefit. A distinction needs to be made between CBT and CBT-informed counselling. Current scope of practice guidelines indicate that psychologist-led CBT may include cognitive restructuring psychotherapy, while CBT-informed counselling by audiologists should not. Conclusion. There is currently equivocal evidence for the efficacy of CBT and counselling for tinnitus management. Extending audiology practice to include CBT may not be a productive approach.