Properties (12)
Year 2025
Abstract Cognitive behavioural therapy (CBT) is an evidence-based intervention for managing distress associated with tinnitus, hyperacusis, and misophonia. This paper summarises key points from the 2025 Tonndorf Lecture presented at the third World Tinnitus Congress and the 14th International Tinnitus Seminar in Poland. The lecture addressed (1) the theoretical foundations of CBT for these conditions, (2) clinical evidence on CBT delivered by psychologists, audiologists, and digital self-help, and (3) the proportion of patients who may benefit from CBT. Research demonstrates that CBT can effectively reduce distress related to tinnitus, hyperacusis, and misophonia. Both psychologist- and audiologist-delivered CBT approaches have demonstrated significant improvements in reducing the impact of tinnitus, hyperacusis, and misophonia on patients’ quality of life, while guided internet-based CBT also demonstrates positive outcomes. Unguided internetbased CBT is also effective, though it faces challenges such as higher dropout rates. Despite these promising results, not all patients experience the same level of benefit. Some continue to experience distress even after completing CBT, highlighting the need for alternative or complementary interventions and ongoing support. This paper estimates that approximately 1 in 52 individuals with tinnitus require CBT, indicating that while tinnitus is relatively common, the need for intensive therapy is comparatively small. To enhance treatment outcomes, future research should compare the effectiveness of psychologist- and audiologist-delivered CBT, explore hybrid models that combine face-to-face and digital interventions, and address challenges with internet-based CBT, particularly for hyperacusis and misophonia. Furthermore, incorporating neuroimaging and physiological measures in future randomised controlled trials could provide objective insights into the neural mechanisms underlying symptom improvement, ultimately helping to refine CBT interventions. Identifying characteristics of non-responders to CBT may also guide the development of more tailored therapeutic approaches.
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Aliases
- Cognitive Behavioural Therapy (CBT) for Managing Tinnitus, Hyperacusis, and Misophonia
- (Aazh, 2025)
Import Date 10-27-2025
Initial Source
Dv Authors
Dv Status #status/Bare-bones-review
Dv Limitations • Not all patients respond equally; persistent symptoms observed in a subset. • Limited large-scale RCTs for hyperacusis and misophonia. • Unguided iCBT has high dropout rates.
Dv Future Directions • Develop hybrid CBT models combining digital and face-to-face formats. • Conduct hop RCTs comparing psychologist- vs audiologist-led interventions. • Incorporate neuroimaging and physiological data to refine models. • Identify and tailor approaches for non-responders. • Clarify diagnostic thresholds distinguishing disorder from non-disorder in hyperacusis and misophonia.
Dv Relevance • a recap from a lecture given at a 2025 tinnitus seminar that talks about the application of CBT to treating tinnitus, hyperacusis and Misophonia • unsurprisingly found good results from CBT for Misophonia , though nots not all people responded to treatment. • a a good source for more in depth info on the specifics of CBT as a method and its application to Misophonia , tinnitus, and hyperacusis.
Checked For Zettle Notes true
Cognitive Behavioural Therapy (CBT) for Managing Tinnitus, Hyperacusis, and Misophonia: The 2025 Tonndorf Lecture
Status:: #status/Bare-bones-review
Metadata
- Item Type: #journalArticle
- Authors:: Hashir Aazh,
- Date:
- Date Added: 1748831940000
- URL: https://www.mdpi.com/2076-3425/15/5/526
- DOI: 10.3390/brainsci15050526
- Cite Key: aazhCognitiveBehaviouralTherapy2025
- Topics: [object Object]
- Tags:: #Bare-bones-review-🦴, #CBT, #hyperacusis, #lecture, #literature-review, #Misophonia, #tinnitus,
- PDF Attachments
Abstract
| Background/Purpose | Background- • Tinnitus, hyperacusis, and misophonia are sound intolerance conditions linked with emotional and functional distress. • CBT has emerged as an effective non-medical treatment option for managing the distress associated with these conditions. • Existing research emphasizes the emotional and attentional biases in patients and supports CBT as a tool to modulate these. Purpose- • Review theoretical foundations and clinical efficacy of CBT (delivered by psychologists, audiologists, or via internet) in managing tinnitus, hyperacusis, and misophonia. • Estimate the proportion of individuals who may benefit from CBT. • Propose improvements in CBT models and explore future research directions. |
| Participants/samples | • Participants from multiple studies including RCTs, uncontrolled clinical trials, and retrospective service evaluations. • Varied samples including general population, clinical patients in NHS, and specific subgroups (e.g., those with comorbid psychiatric conditions). |
| Measures | • Self-report questionnaires: THI, HQ, MIQ, TIQ, AMISOS-R, SAD-T, PHQ-9. • Behavioural responses: avoidance, use of hearing protection, social withdrawal, emotional reactions. • Physiological responses (in literature review): brain imaging (amygdala, insula activity), autonomic responses (e.g., ASMR). |
| Procedures | • CBT involved psychoeducation, cognitive restructuring, behavioural experiments, and empathic listening. • Delivery modes included psychologist-led, audiologist-led (face-to-face or video), and internet-based (guided/unguided). • Intervention durations varied (e.g., 6 weeks to 9 months), with session formats tailored to patient needs. |
| Results | • Psychologist-delivered CBT for tinnitus: ES up to 0.7; reduced tinnitus impact and depressive symptoms. • Audiologist-delivered CBT: ES up to 2.6 (pre-post); highly acceptable to patients; beneficial even with comorbid psychological conditions. • iCBT (guided): ES 0.45 to 1.06; high patient engagement and sustainability of improvement. • iCBT (unguided): ES 0.6-1.38; high dropout rates (~51%) but still effective. • Hyperacusis: CBT improved HQ and ULLs scores; ES 0.69-1.13 in RCTs. • Misophonia: Group CBT (psychologist-led) ES 1.97; audiologist-led CBT (video) ES 0.73. |
| Discussion/Limits | Conclusion- • CBT is effective in reducing distress for tinnitus, hyperacusis, and misophonia. • Both psychologist- and audiologist-delivered CBT approaches show strong efficacy. • iCBT presents a viable, accessible alternative with promising outcomes. |
| Limitations:: | • Not all patients respond equally; persistent symptoms observed in a subset. • Limited large-scale RCTs for hyperacusis and misophonia. • Unguided iCBT has high dropout rates. |
| Future Directions:: | • Develop hybrid CBT models combining digital and face-to-face formats. • Conduct RCTs comparing psychologist- vs audiologist-led interventions. • Incorporate neuroimaging and physiological data to refine models. • Identify and tailor approaches for non-responders. • Clarify diagnostic thresholds distinguishing disorder from non-disorder in hyperacusis and misophonia. |
| Relevance:: | • a recap from a lecture given at a 2025 tinnitus seminar that talks about the application of CBT to treating tinnitus, hyperacusis and Misophonia • unsurprisingly found good results from CBT for Misophonia , though nots not all people responded to treatment. • a a good source for more in depth info on the specifics of CBT as a method and its application to Misophonia , tinnitus, and hyperacusis. |
Notes
key terms and concepts
- Tinnitus - The perception of sound without an external auditory stimulus, often experienced as ringing in the ears.
- Hyperacusis - A condition involving heightened sensitivity to everyday sounds, perceived as excessively loud or uncomfortable.
- Misophonia - A sound intolerance disorder characterized by intense emotional reactions to specific trigger sounds, often related to human-generated noises (e.g., chewing).
- Cognitive Behavioural Therapy (CBT) - A structured, evidence-based psychological treatment focusing on modifying maladaptive thoughts and behaviours.
- iCBT - Internet-based Cognitive Behavioural Therapy, which can be guided or unguided and provides digital therapeutic interventions.
- THI (Tinnitus Handicap Inventory) - A questionnaire assessing the impact of tinnitus on daily functioning.
- HQ (Hyperacusis Questionnaire) - A scale for measuring symptoms and distress associated with hyperacusis.
- MIQ (Misophonia Impact Questionnaire) - A self-report tool used to assess the severity of misophonia.
- Effect Size (ES) - A quantitative measure of the magnitude of treatment effects, with 0.2 = small, 0.5 = medium, 0.8+ = large.