In this study, researchers are examining the best sequence of interventions for posttraumatic stress disorder (PTSD) and tinnitus. Participants will either receive psychotherapy for PTSD first (Cognitive Processing Therapy; CPT), followed by treatment for tinnitus (Cognitive Behavioral Therapy for Tinnitus; CBT-t); or vice-versa. We also aim to identify changes in brain functioning after receiving therapy.

After consenting to this study, study participants will be asked to speak with a study staff member about stressful or traumatic experiences, complete hearing assessments and questionnaires about exposure to traumatic events, PTSD symptoms, mental and physical health problems, such as depression and substance use, head injuries, and tinnitus. Participants who are able and willing may be asked to provide functional magnetic resonance imaging (MRI) scans before and after treatment. Participants will receive treatment for tinnitus and posttraumatic stress disorder (PTSD) in one of two ways: Cognitive Processing Therapy (CPT) first and then Cognitive Behavioral Therapy for Tinnitus (CBT-t) OR CBT-t first, followed by CPT.

Inclusion Criteria:

• Adult male and female active duty military personnel and veterans seeking treatment for PTSD
• Diagnosis of PTSD
• Person has experienced at least one mild traumatic brain injury (concussion)
• Ability to speak and read English
• Stable on any psychotropic medications
• Meets criteria for chronic subjective and bothersome tinnitus
• Chronic tinnitus is at least possibly related to head injury

Exclusion Criteria:

• Currently receiving other talk therapies
• Severe hearing loss that would prevent the participant from benefiting from therapy
• Current severe suicidal ideation
• Psychiatric hospitalization in the last 12 months
• Moderate to severe substance use that would prevent the participant form benefiting from therapy
• Current manic episode or psychotic symptoms requiring immediate stabilization or hospitalization
• Significant cognitive impairment
• Moderate to severe brain damage
• Neurobiological disorders
• Temporomandibular joint disorders and/or Meniere's disease that cause acute pain

At the conclusion of this study, participants who signed the consent to have their data placed in the STRONG STAR Repository will be maintained under the UTHSCSA IRB-approved Repository protocol. For participants who decline participation in the STRONG STAR Repository, at the conclusion of the study their data will be de-identified and the data maintained in the Repository without identifiers. The IRB approved STRONG STAR Repository is a large comprehensive database of information, biological specimens and neuroimages related to the identification, assessment, and treatment of posttraumatic stress disorder (PTSD), insomnia, pain, and related behavioral health conditions. No biospecimen data is being collected in this study.

Unending: Beginning immediately after publication with no end date.