CBT for tinnitus: what it is and why guidelines recommend it

Cognitive behavioural therapy (CBT) for tinnitus is a structured talking therapy that helps you change how you think about and react to the sound. It does not make tinnitus disappear, but it has the strongest evidence of any approach for reducing the distress tinnitus causes, and guidelines in the UK, the US and Germany recommend it.

Last reviewed: 28 October 2026

By the Tinnitus Haven editorial team. Sources are listed at the end of the page.

This guide is general information, not medical advice. If your tinnitus is new, one-sided, pulsing or comes with hearing loss or dizziness, see a doctor.

What is CBT for tinnitus?

CBT is a family of psychological treatments built on how thoughts, feelings and behaviour affect each other^[1]. In tinnitus-related CBT, common parts include^{[2, 3]}:

learning how tinnitus works, which on its own can reduce anxiety
noticing unhelpful thoughts about the sound and learning to challenge them
positive imagery
focusing on changes you can make to reduce the impact of tinnitus on your life

The aim is habituation: the sound may still be there, but you notice it less and it bothers you less. Even partial progress toward that can make a real difference^[4].

Does CBT work for tinnitus?

A 2020 Cochrane review combined 28 trials with 2,733 adults who had tinnitus for at least three months^[1]. It found that:

Compared with no treatment or a waiting list, CBT may reduce the impact of tinnitus on quality of life by the end of treatment (low certainty evidence). The average difference was about 11 points on the 100 point Tinnitus Handicap Inventory, above the 7 points usually seen as a meaningful change.
Compared with audiology-based care, CBT probably reduces the impact of tinnitus (moderate certainty).
CBT may slightly reduce depression, but its effects on anxiety and general quality of life are uncertain.
Serious side effects appear to be rare.
There was not enough evidence about effects 6 or 12 months later.

In plain terms, CBT will not switch tinnitus off, but it can make it less distressing. Experts describe it as the tinnitus management approach with the most robust evidence^[5].

What do clinical guidelines say?

United States (AAO-HNSF, 2014): clinicians should recommend CBT to people with persistent, bothersome tinnitus^[6].
United Kingdom (NICE, 2020): if tinnitus still causes distress after initial support, a stepped approach: first digital tinnitus-related CBT provided by psychologists, then group-based therapies such as mindfulness-based cognitive therapy, acceptance and commitment therapy or CBT, then individual CBT^[3].
Germany (S3 guideline, 2021): behavioural therapy for chronic tinnitus receives a strong recommendation, based on high level evidence^[4].

The NHS notes that people are usually offered digital CBT first, through an online programme or app^[7].

Can I do CBT online or with an app?

Internet-based CBT for tinnitus has been tested in several trials. Some found it about as effective as face-to-face therapy, while others favoured face-to-face sessions^[4]. In NICE's sense, digital CBT is delivered on a computer, tablet or phone and provided by psychologists^[3].

Self-guided apps are a different matter. The German guideline cites a review of 34 tinnitus apps that found all of them lacked scientific evidence^[4]. An app with CBT-based lessons can be a gentle introduction and a way to practise skills between appointments, but it is not the same as therapy with a qualified psychologist.

How can I get CBT for tinnitus?

Ask your GP or ENT doctor. They may refer you for a talking therapy, and in the UK you will usually be offered digital CBT first^[7].
Look for a psychologist with experience in tinnitus, or a programme recommended by your clinic.
Mention your mood and sleep, not only the sound. Anxiety and depression should be assessed and treated in their own right^{[3, 4]}.

If tinnitus mostly troubles you at night, CBT for insomnia may be worth asking about; see our tinnitus and sleep guide. For mindfulness and breathing, see tinnitus, stress and anxiety.

Tinnitus Haven brings sound therapy, a hearing check and CBT-based lessons together in one calm iPhone app, coming soon to the App Store. Learn more about Tinnitus Haven.

Sources

Fuller T, Cima R, Langguth B, et al. Cognitive behavioural therapy for tinnitus. Cochrane Database of Systematic Reviews, 2020.
National Institute on Deafness and Other Communication Disorders (NIDCD), NIH. Tinnitus. 2023.
National Institute for Health and Care Excellence (NICE). Tinnitus: assessment and management (NG155), Recommendations. NICE guideline, 2020.
Mazurek B, Hesse G, Sattel H, et al. S3 Guideline: Chronic Tinnitus. German Society for Otorhinolaryngology, Head and Neck Surgery (DGHNO-KHC). HNO, 2022. English version of the German AWMF guideline 017/064 (2021).
McKenna L, Vogt F, Marks E. Current validated medical treatments for tinnitus: cognitive behavioral therapy. Otolaryngologic Clinics of North America, 2020.
Tunkel DE, Bauer CA, Sun GH, et al. Clinical practice guideline: tinnitus. Otolaryngology, Head and Neck Surgery, 2014 (AAO-HNSF).
NHS. Tinnitus. NHS website, 2024.