Audiologist-Delivered CBT for Tinnitus, Hyperacusis & Misophonia (webinar 20th August 2020)


Dr. Hashir Aazh is the team-lead for the Tinnitus & Hyperacusis Therapy Clinic, Royal Surrey NHS Foundation Trust (Guildford). He also works in private practice. He has written over 50 scientific papers in the field of Audiology. Hashir is the course director for the Tinnitus Masterclass and the organiser of the International Conference on Hyperacusis and Misophonia.


Audiologist-Delivered CBT for Tinnitus, Hyperacusis & Misophonia

Hashir Aazh PhD, Tinnitus & Hyperacusis Therapy Specialist Clinic, Audiology Department, The Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, GU2 7XX , United Kingdom


Offering Cognitive Behavioural Therapy (CBT) delivered by audiologists may improve access to this intervention for many patients experiencing tinnitus, hyperacusis and misophonia. Audiologist-delivered CBT is broadly similar to CBT delivered by a mental health professional and includes (1) Empathic listening informed by the client-centered counseling method; (2) Developing a case formulation that provides an explanation of the mechanism by which tinnitus/hyperacusis/misophonia lead to distress, based on cognitive theory; (3) Application of behavioral experiments in order to explore and modify negative thoughts and safety-seeking behaviors; (4) Keeping of a Diary of Thoughts and Feelings (DTF) to provide a structured method for the patient to take notes about their tinnitus and/or sound-related problems, and their associated thoughts and emotions. The DTF is completed by patients between sessions. During the session, the audiologist uses the Socratic questioning style to encourage the patient to think of the advantages and disadvantages of the thoughts that they recorded in the DTF, and to modify them if the patient decided that their thoughts were unrealistic or unhelpful.

Several clinical studies conducted in the NHS show that audiologist-delivered CBT is a feasible, efficient and effective method of service delivery. In addition, for audiologists who have specialized in this field, this is the most rewarding part of their job. Finally, our research showed that the majority of patients reported that it was very acceptable to them to receive CBT focused on tinnitus and hyperacusis from a specialist audiologist; the median response was 10/10. The majority of patients felt that the CBT was very effective (median response 8/10) and that they were able to manage their tinnitus and/or hyperacusis well (median response 9/10).

To conclude, audiologist-delivered CBT is acceptable to patients and is effective in the management of tinnitus and/or hyperacusis from the patients’ perspectives.

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