Cognitive behavioural therapy for tinnitus

Fuller, Thomas; Cima, Rilana; Langguth, Berthold; Mazurek, Birgit; Vlaeyen, Johan WS; Hoare, Derek J

doi:10.1002/14651858.cd012614.pub2

Cited by 212Hearing, Cochlea, Tinnitus, GeneticsHearing Loss and RehabilitationNoise Effects and Management

Cognitive behavioural therapy for tinnitus

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Fuller, Thomas, Cima, Rilana, Langguth, Berthold, Mazurek, Birgit, Vlaeyen, Johan WS, Hoare, Derek J·2020·Cochrane Database of Systematic Reviews

DOI 10.1002/14651858.cd012614.pub2

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Abstract

CBT versus audiological care (tinnitus education and rehabilitation for hearing loss), Outcome 3 Depression at end of treatment..........................

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There is low certainty to support the use of cognitive behavioral therapy for depression and anxiety in people with tinnitus due to the methodological quality of evidence.
“there is low certainty to support its use for depression and anxiety in people with tinnitus due to the methodological quality of evidence (Fuller et al., 2020).”
From A Systematic Review and Meta-Analysis Exploring Effects of Third-Wave Psychological Therapies on Hearing-Related Distress, Depression, Anxiety, and Quality of Life in People With Audiological Problems. (2022) · cites this paper as Fuller et al., 2020
The Authors’ conclusions (page unavailable) report a possible small benefit for depression, with uncertainty due to concerns about evidence quality. They describe evidence for improving anxiety as limited, and the Implications for practice say there is insufficient evidence to recommend tinnitus-focused CBT when improving anxiety is the primary aim. The claim therefore overstates support for its use for anxiety and treats the certainty for both outcomes as uniformly low. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Compared to audiological care and tinnitus retraining therapy, CBT is more effective in improving quality of life.
“Compared to audiological care and tinnitus retraining therapy, CBT is more effective in improving quality of life.”
From Research trends and hotspots of cognitive behavioral therapy for tinnitus: a bibliometric analysis (2025) · cites this paper as Fuller et al., 2020
The ‘CBT versus audiological care’ section reports that CBT probably reduces tinnitus’s impact on quality of life compared with audiological care. The ‘CBT versus tinnitus retraining therapy’ section reports a possible benefit, but it is based on one study with low-certainty evidence; the Discussion says there is insufficient evidence to conclude that CBT is superior to TRT. The claim states that comparison more definitively than the source supports. (LLM, conf=0.88)
Experimental — accuracy not yet measured
CBT is the first-line evidence-based psychotherapy for tinnitus and aims to modify dysfunctional beliefs and behaviours to reduce annoyance and distress.
“CBT is the first-line evidence-based psychotherapy for tinnitus, and it aims to modify dysfunctional beliefs and behaviours in order to reduce the annoyance and distress associated with tinnitus.7”
From SoundMind Trial: a study protocol for a randomised controlled trial for online acceptance and commitment therapy and sound therapy for tinnitus (2024) · cites this paper as [7]
The Description of the intervention says CBT addresses dysfunctional thoughts and behavioural responses to reduce tinnitus’s impact on quality of life. The Authors’ conclusions report evidence of benefit and note that clinical guidelines endorse CBT for chronic bothersome tinnitus, but the passages do not establish that it is the first-line psychotherapy. (LLM, conf=0.87)
Experimental — accuracy not yet measured
There is a lack of reliable and consistent evidence on the efficacy of individual and combination tinnitus treatments.
“There is a lack of reliable and consistent evidence on the efficacy of the individual and combination treatments, such as audiological care and psychological treatment.”
From Combining the unequal variance signal detection model with the health belief model to optimize shared decision making in tinnitus patients: part 2—patient profiling (2025) · cites this paper as Fuller et al., 2020
The Completeness section (page unavailable) says there were too few studies comparing CBT with audiological care or tinnitus retraining therapy to reach a conclusion, and that evidence for comparisons with other active interventions was of low certainty. But it also reports moderate-certainty evidence that CBT is superior to wait-list control at the end of treatment. The review therefore supports uncertainty about some comparisons, not a general lack of reliable evidence for all individual and combination tinnitus treatments. (LLM, conf=0.86)
Experimental — accuracy not yet measured
The lack of reliable and consistent evidence on tinnitus treatment efficacy is due to different study designs and lack of reproducible results.
“This is due to different study designs and lack of reproducible results (Fuller et al., 2020; Hoare et al., 2014; Sereda et al., 2018).”
From Combining the unequal variance signal detection model with the health belief model to optimize shared decision making in tinnitus patients: part 2—patient profiling (2025) · cites this paper as Fuller et al., 2020
The Quality of the evidence section (page unavailable) says that inconsistency between results lowered certainty for some CBT comparisons, and Assessment of heterogeneity (page unavailable) considers differences in study design. The paper does not establish that different designs and a lack of reproducible results explain unreliable evidence for tinnitus treatments generally; its findings concern CBT specifically. (LLM, conf=0.86)
Experimental — accuracy not yet measured

CBT-based programs seem to help reduce distress symptoms and cognitive dysfunctions, improve pain management, and increase well-being in AP-ROD.
“Programs based on a CBT approach seem to help reduce distress symptoms and cognitive dysfunctions, improve pain management, and increase well-being [19–21].”
From Connect-ROD – development and qualitative evaluation of a community-based group intervention to support well-being in patients with a rare or orphan disease (2024) · cites this paper as [20]
The Discussion (Summary of main results; page not provided) reports small benefits of CBT for depression, anxiety, negatively biased interpretations of tinnitus, and tinnitus-related quality of life. The review concerns people with tinnitus, not AP-ROD; these findings do not establish improved pain management or reduced cognitive dysfunction more broadly. It also says the evidence for improved general quality of life is insufficient. (LLM, conf=0.88)
Experimental — accuracy not yet measured
The most cited paper (39 citations) was 'Cognitive behavioral therapy for tinnitus (Fuller et al., 2020),' published in the Cochrane Database of Systematic Reviews.
“The most cited paper (39 citations) was “Cognitive behavioral therapy for tinnitus (Fuller et al., 2020),” published in the Cochrane Database of Systematic Reviews.”
From Research trends and hotspots of cognitive behavioral therapy for tinnitus: a bibliometric analysis (2025) · cites this paper as Fuller et al., 2020
CBT rarely leads to any adverse effects.
“Furthermore, CBT rarely leads to any adverse effects, but further research is needed to verify its long-term efficacy (Fuller et al., 2020).”
From Research trends and hotspots of cognitive behavioral therapy for tinnitus: a bibliometric analysis (2025) · cites this paper as Fuller et al., 2020
CBT may to a lesser extent reduce depressive symptoms compared to no treatment or waiting list control for tinnitus.
“This review, through the analysis of 28 randomized controlled trials, found that compared to no treatment or waiting list control for tinnitus, CBT significantly improved the severity of tinnitus and may to a lesser extent reduce depressive symptoms.”
From Research trends and hotspots of cognitive behavioral therapy for tinnitus: a bibliometric analysis (2025) · cites this paper as Fuller et al., 2020
CBT significantly improved the severity of tinnitus compared to no treatment or waiting list control for tinnitus.
“This review, through the analysis of 28 randomized controlled trials, found that compared to no treatment or waiting list control for tinnitus, CBT significantly improved the severity of tinnitus and may to a lesser extent reduce depressive symptoms.”
From Research trends and hotspots of cognitive behavioral therapy for tinnitus: a bibliometric analysis (2025) · cites this paper as Fuller et al., 2020
There is little consensus on treatment effectiveness for chronic tinnitus.
“Despite the extensive literature, there is little consensus on treatment effectiveness for chronic tinnitus (Fuller et al., 2020; Marks et al., 2019).”
From Combining the unequal variance signal detection model with the health belief model to optimize shared decision making in tinnitus patients: part 2—patient profiling (2025) · cites this paper as Fuller et al., 2020
Cognitive behavioral therapy (CBT) is regarded as the intervention with the most evidence for efficacy in reducing tinnitus distress and is strongly recommended in German guidelines for chronic tinnitus.
“Cognitive behavioral treatment approaches reproducibly help patients in managing chronic tinnitus.”
From Randomized controlled trial of a smartphone-based cognitive behavioral therapy for chronic tinnitus (2023) · cites this paper as [16]

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Flagged first, then by citations

3 of the 201 references couldn’t be matched to a known paper.

Research works printed but not linked: 12

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Sorted by citations

Tinnitus prevalence in Europe: a multi-country cross-sectional population study
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Bimodal neuromodulation combining sound and tongue stimulation reduces tinnitus symptoms in a large randomized clinical study
Conlon, B. J., Langguth, B., Hamilton, C., Hughes, S., Meade, E., Connor, C. O., Schecklmann, M., Hall, D. A., Vanneste, S., Leong, S. L., et al. (2020) · Science Translational Medicine · doi:10.1126/scitranslmed.abb2830 · Cited by 115 · see citing works
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Tinnitus and the Triple Network Model: A Perspective
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Tinnitus Guidelines and Their Evidence Base
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S3 Guideline: Chronic Tinnitus
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Clinical practice guideline: Chronic tinnitus—diagnosis and treatment
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The Effect of Environmental Stressors on Tinnitus: A Prospective Longitudinal Study on the Impact of the COVID-19 Pandemic
Schlee, W., Hølleland, S., Bulla, J., Simoes, J. P., Neff, P. K. A., Schoisswohl, S., Wölflick, S., Schecklmann, M., Schiller, A., Staudinger, S., et al. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9092756 · Cited by 52 · see citing works
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The Current State of Tinnitus Diagnosis and Treatment: a Multidisciplinary Expert Perspective
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Internet-Based Audiologist-Guided Cognitive Behavioral Therapy for Tinnitus: Randomized Controlled Trial
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Different bimodal neuromodulation settings reduce tinnitus symptoms in a large randomized trial
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Recent Updates on Tinnitus Management
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Multidisciplinary Tinnitus Research: Challenges and Future Directions From the Perspective of Early Stage Researchers
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A contribution to the debate on tinnitus definition
Noreña, A. J., Lacher-Fougere, S., Estève-Fraysse, M.-J., Bizaguet, É., Grevin, P., Van, H. T., Moati, L., Pajolec, C. L., Fournier, P., & Ohresser, M. (2021) · Progress in brain research · doi:10.1016/bs.pbr.2021.01.029 · Cited by 39 · see citing works
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Health-Related Quality of Life, Depressive Symptoms, Anxiety, and Somatization Symptoms in Male and Female Patients with Chronic Tinnitus
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Audiologist-Supported Internet-Based Cognitive Behavioral Therapy for Tinnitus in the United States: A Pilot Trial
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Exploratory Data Mining Techniques (Decision Tree Models) for Examining the Impact of Internet-Based Cognitive Behavioral Therapy for Tinnitus: Machine Learning Approach (Preprint)
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Neurophysiological correlates of residual inhibition in tinnitus: Hints for trait-like EEG power spectra
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Unification of Treatments and Interventions for Tinnitus Patients (UNITI): a study protocol for a multi-center randomized clinical trial
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Tinnitus und beeinflussende Komorbiditäten
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Current and Emerging Therapies for Chronic Subjective Tinnitus
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Cognitive behavioural therapy (CBT) with and without exercise to reduce fear of falling in older people living in the community
Lenouvel, E., Ullrich, P., Siemens, W., Dallmeier, D., Denkinger, M. D., Kienle, G. S., Zijlstra, G. A. R., Hauer, K. A., & Klöppel, S. (2023) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd014666.pub2 · Cited by 29 · see citing works
The Comorbidity of Depression and Anxiety Symptoms in Tinnitus Sufferers: A Network Analysis
Chen, X., Ren, L., Xue, X., Yu, N., Liu, P., Shen, W., Zhou, H., Wang, B., Zhou, J., Yang, S., et al. (2023) · Brain Sciences · doi:10.3390/brainsci13040583 · Cited by 29 · see citing works
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Effectiveness of telerehabilitation interventions for self-management of tinnitus: systematic review
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State of the art: non-invasive electrical stimulation for the treatment of chronic tinnitus
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Psychological Comorbidities of Tinnitus
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Current Validated Medical Treatments for Tinnitus
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Neuromodulation Treatments Targeting Pathological Synchrony for Tinnitus in Adults: A Systematic Review
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Systematic Evaluation of the T30 Neurostimulator Treatment for Tinnitus: A Double-Blind Randomised Placebo-Controlled Trial with Open-Label Extension
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Cortical auditory evoked potentials, brain signal variability and cognition as biomarkers to detect the presence of chronic tinnitus
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Associations Between Physical Activity, Tinnitus, and Tinnitus Severity
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Randomized controlled trial of a smartphone-based cognitive behavioral therapy for chronic tinnitus
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Dual-site transcranial direct current stimulation to treat tinnitus: a randomized controlled trial
Cardon, E., Jacquemin, L., Vermeersch, H., Joossen, I., Moyaert, J., Mertens, G., Vanderveken, O. M., Lammers, M. J. W., de Heyning, P. V., Rompaey, V. V., et al. (2022) · Brain · doi:10.1093/brain/awac263 · Cited by 17 · see citing works
Spectrally Matched Near-Threshold Noise for Subjective Tinnitus Loudness Attenuation Based on Stochastic Resonance
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Tinnitus, Hyperacusis, Otalgia, and Hearing Loss
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Process mining in mHealth data analysis
Winter, M. R., Langguth, B., Schlee, W., & Pryss, R. C. (2024) · npj Digital Medicine · doi:10.1038/s41746-024-01297-0 · Cited by 17 · see citing works
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Reevaluating the Use of Sound Therapy for Tinnitus Management: Perspectives on Relevant Systematic Reviews
Henry, J. A., Carlson, K. F., Theodoroff, S. M., & Folmer, R. L. (2022) · Journal of Speech Language and Hearing Research · doi:10.1044/2022_jslhr-21-00668 · Cited by 16 · see citing works
Pilot study of a smartphone-based tinnitus therapy using structured counseling and sound therapy: A multiple-baseline design with ecological momentary assessment
Engelke, M., Simoes, J. P., Vogel, C., Schoisswohl, S., Schecklmann, M., Wölflick, S., Pryss, R. C., Probst, T., Langguth, B., & Schlee, W. (2023) · PLOS Digital Health · doi:10.1371/journal.pdig.0000183 · Cited by 15 · see citing works
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Delivery of internet-based cognitive behavioral therapy combined with human-delivered telepsychology in tinnitus sufferers through a chatbot-based mobile app
Bardy, F., Jacquemin, L., Wong, C. L., Maslin, M. R. D., Purdy, S. C., & Thai-Van, H. (2024) · Frontiers in Audiology and Otology · doi:10.3389/fauot.2023.1302215 · Cited by 14 · see citing works
Is There an Optimal Repetitive Transcranial Magnetic Stimulation Target to Treat Chronic Tinnitus?
Watson, N., Schaper, F. L. W. V. J., Jabbour, S., Sadler, S. J., Bain, P. A., Fox, M., & Naples, J. G. (2022) · Otolaryngology · doi:10.1177/01945998221102082 · Cited by 14 · see citing works
Screening for Circulating Inflammatory Proteins Does Not Reveal Plasma Biomarkers of Constant Tinnitus
Cederroth, C. R., Hong, M., Freidin, M. B., Edvall, N. K., Trpchevska, N., Jarach, C. M., Schlee, W., Schwenk, J. M., Lopez-Escamez, J. A., Gallus, S., et al. (2023) · Journal of the Association for Research in Otolaryngology · doi:10.1007/s10162-023-00920-3 · Cited by 14 · see citing works
Estimation of Minimal Clinically Important Difference for Tinnitus Handicap Inventory and Tinnitus Functional Index
Engelke, M., Basso, L., Langguth, B., Zeman, F., Schlee, W., Schoisswohl, S., Cima, R. F. F., Kikidis, D., Lopez-Escamez, J. A., Brüeggemann, P., et al. (2025) · Otolaryngology · doi:10.1002/ohn.1217 · Cited by 14 · see citing works
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A Three-arm, Single-blind, Randomized Controlled Trial Examining the Effects of Notched Music Therapy, Conventional Music Therapy, and Counseling on Tinnitus
Piromchai, P., Srisukhumchai, C., Kasemsiri, P., Vatanasapt, P., Thanawirattananit, P., Chayaopas, N., Srirompotong, S., & Yimtae, K. (2020) · Otology & Neurotology · doi:10.1097/mao.0000000000002935 · Cited by 14 · see citing works
Smartphone-Guided Educational Counseling and Self-Help for Chronic Tinnitus
Schlee, W., Neff, P. K. A., Simoes, J. P., Langguth, B., Schoisswohl, S., Steinberger, H., Norman, M., Spiliopoulou, M., Schobel, J., Hannemann, R., et al. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11071825 · Cited by 14 · see citing works
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Continuous Improvement of Chronic Tinnitus Through a 9-Month Smartphone-Based Cognitive Behavioral Therapy: Randomized Controlled Trial
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Negative Associations of Stress and Anxiety Levels With Cytotoxic and Regulatory Natural Killer Cell Frequency in Chronic Tinnitus
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Authors: Fuller, T., Cima, R., Langguth, B., Mazurek, B., Vlaeyen, J. W., & Hoare, D. J.
Affiliations: Maastricht University (NL)
University of Regensburg (DE)
Charité – Universitätsmedizin Berlin (DE)
KU Leuven (BE)
University of Nottingham (GB)
ORCID: Cima, Rilana
Langguth, Berthold
Mazurek, Birgit
Vlaeyen, Johan WS
Hoare, Derek J
Venue: Cochrane Database of Systematic Reviews
Publisher: Wiley
Published: 2020-01-08
Volume: 2020
Issue: 1
ISSN: 1361-6137 (ISSN-L)
1465-1858
DOI: 10.1002/14651858.cd012614.pub2
OpenAlex: W4211059041
Cited by: 212
References: 201
Citations by year: 2026: 14 · 2025: 30 · 2024: 37 · 2023: 43 · 2022: 39 · 2021: 35 · 2020: 13 · 2019: 1
FWCI: 4.24
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Cochrane Database of Systematic Reviews (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
Lirias (submittedVersion, other-oa)
Research Publications (Maastricht University) (submittedVersion, other-oa)
Funders: National Institute for Health and Care Research
Topics: Life Sciences › Neuroscience › Sensory Systems › Hearing, Cochlea, Tinnitus, Genetics
Life Sciences › Neuroscience › Cognitive Neuroscience › Hearing Loss and Rehabilitation
Health Sciences › Health Professions › Speech and Hearing › Noise Effects and Management
Keywords: cognitive behavioral therapy, tinnitus, depression, tinnitus rehabilitation, hearing loss, treatment outcomes

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