Introduction to iCBT for Tinnitus

Specialised cognitive behavioural therapy (CBT) delivered by audiologists and/or psychologists is a key rehabilitative intervention for managing distressing tinnitus. Targeted CBT for tinnitus is often delivered over 6 to 14 face-to-face individual sessions. Internet-based CBT approaches (iCBT) for tinnitus management also shown promising results in recent clinical trials. The cost associated with iCBT is less than face-to-face sessions which makes the treatment more accessible when there are shortages of resources or financial limitations. Due to these reasons iCBT has been recommended by the National Institute for Health and Care Excellence (NICE) as the first step in tinnitus management. Patients who do not improve after iCBT may be offered more intensive face-to-face individual sessions.

The iCBT introduced in this training course can be used as guided (therapist guiding the patient on how to use the programme and offer further counselling and support) or unguided (as a standalone treatment) approach. If used as a guided iCBT, then patients will benefit from the additional support that their clinician is providing which can help them to engage with the programme. Unguided iCBT does not have the additional support from a therapist, however, it is less costly and research studies seem to suggest that unguided iCBT is also beneficial in reducing tinnitus distress. Depending on the service that you are providing and your resources you can decide whether to use this programme as guided or unguided approach.

This training course is designed for those who wish to utilise iCBT for adults experiencing tinnitus disorder. Participants will learn the details of the iCBT for tinnitus programme and gain the required knowledge with regard to using it as a guided or unguided approach. The content of this course has been certified by the CPD Certification Service as conforming to continuing professional development principles. The course has 4 CPD points.

The course is delivered online and has 3 hours of recorded video presentations and a one hour live group supervision session (via zoom). First presentation is on theoretical aspects of iCBT for tinnitus. The remaining six presentations are dedicated to demonstrating what happens at each of the iCBT modules comprising: (1) 4C and assessment module, (2) Introduction to CBT for Tinnitus, (3) Behavioural Experiment for Tinnitus, (4) Challenge Your Negative Thoughts, (5) Diary of Thoughts and Feelings, (6) Positive Psychology in Tinnitus Management and Final Assessment.

Aims and objectives for each presentation are shown below:

Theoretical aspects of iCBT for tinnitus

Learn about the basic concepts of CBT for tinnitus management, research on iCBT, and further training opportunities to specialise in rehabilitative therapies for tinnitus, hyperacusis, and misophonia management.

Demonstration of “4C and Assessment” iCBT module

Learn what the assessment module of iCBT offers to your patients. You may choose to complete this module together with your patient or to let them do it independently. In this module, there is list of questions about tinnitus, ear and hearing problems, and two short standardised questionnaires: 4C tinnitus management and screening for anxiety and depression in tinnitus (SAD-T). After completing the assessment module, a report is developed automatically and sent to the email address that the user provides (either yours or your patient’s). The report contains recommendations for further medical evaluations and/or psychological support (if indicated based on their answers to the questions).

Demonstration of “Introduction to CBT for Tinnitus” iCBT module

The module 2 of iCBT is demonstrated in this presentation. In module 2, patients should be able to:

• Describe what tinnitus is.
• Describe CBT and its relevance to tinnitus distress.
• Apply a simple CBT model to tinnitus distress.
• Differentiate between events, thoughts and emotions.
• Create a CBT model explaining their own experience of tinnitus distress and describe how this model can be used in guiding their tinnitus management.

Demonstration of “Behavioural Experiment for Tinnitus” iCBT module

This presentation covers a lot of theoretical and practical details about module 3 of iCBT. This module provides an opportunity to explore and challenge tinnitus-related negative thoughts by testing out different behaviours. This module has two sections. When they complete section one, an email is sent to them with a link to the second section. By the end of this session, patients should be able to:

• Describe what a behavioural experiment is.
• Explore their irrational thoughts and predictions about tinnitus and its impact on them.
• Analyse the link between automatic thoughts and emotions.
• Differentiate between literal facts and thoughts.
• Design a behavioural experiment to test the validity of their tinnitus-related thoughts.
• Challenge their unhelpful thoughts.
• Create counter-statements.
• Use the counter-statements in real life scenarios.

Demonstration of “Challenge Your Negative Thoughts” iCBT module

In this presentation, how to help patients learning to challenge their irrational thoughts is described. In module 4, patients learn about common forms of cognitive distortions and develop the skills to identify errors of judgment in their own tinnitus-related perceptions. By the end of this module, patients should be able to:

• Describe the relationship between tinnitus, anxiety and negative thoughts.
• Differentiate the levels of thoughts: automatic thoughts, rules of life and core beliefs.
• Explain the mechanism by which tinnitus perception can lead to distress based on the levels of thoughts.
• List the 10 common forms of cognitive distortion.
• Differentiate different forms of cognitive distortion.
• Identify errors of judgment in their own tinnitus-related perceptions.

Demonstration of “Diary of Thoughts and Feelings” iCBT module

In this presentation, the concept of how to use CBT skills in managing tinnitus distress is clearly described. Module 5, provides a tool in order to combine the different techniques that they have learned in the previous modules in order to identify and challenge negative automatic thoughts. By the end of this module, patients should be able to:

• Identify tinnitus-related distress in their day-to-day life.
• Distinguish between tinnitus-related distress and the distress caused by other underlying psycho-social and medical factors.
• Explore and record what goes through their mind when they are bothered by their tinnitus.
• Identify their thought distortions.
• Identify and record their emotional reactions to tinnitus-related thoughts.
• Develop counter-statements (more helpful and rational thoughts) that can substitute for tinnitus-related negative thoughts.

Demonstration of “Positive Psychology in Tinnitus Management” and the “Final Assessment” iCBT modules

Here the concepts of positive psychology and how that can help your patient is described. In addition, you will learn about the function of the final assessment module. By the end of module 6, patients should be able to:

• Describe how acceptance can help them in managing their tinnitus.
• List common human character strengths and virtues.
• Identify their own character strengths and discuss how they can help them in accepting of tinnitus.
• Use their character strengths in generating optimism and resilience.

The final assessment module helps to (1) establish the progress each patient has made in tinnitus management, and (2) enhance their confidence and motivation in using CBT skills for tinnitus management.