Counseling and Cognitive Behavioral Therapy for tinnitus—The same but different: a scoping review

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 counseling 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 counseling, commonly in the form of psychoeducation, is frequently used in tinnitus practice by audiologists. Tinnitus counseling aims to reduce the negative impact that tinnitus has on patients' lives. Counseling 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 counseling 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, counseling 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 counseling are helpful, but there is no clear evidence that one is superior to the other. It is also unclear what elements of CBT or counseling contribute the most benefit. A distinction needs to be made between CBT and CBT-informed counseling. Current scope of practice guidelines indicate that psychologist-led CBT may include cognitive restructuring psychotherapy, while CBT-informed counseling by audiologists (aCBT) should not. Conclusion There is currently equivocal evidence for the efficacy of CBT and counseling for tinnitus management. Extending audiology practice to include CBT may not be a productive approach.