A Review of psychological treatment approaches for patients suffering from tinnitus

Two birds with one stone.-Addressing depressive symptoms, emotional tension and worry improves tinnitus-related distress and affective pain perceptions in patients with chronic tinnitus

BACKGROUND

Psychological factors link the co-occurrence of tinnitus-related distress and pain perceptions in patients with chronic tinnitus.

OBJECTIVE

This study examines, if treatment-related changes in these factors ameliorate both tinnitus-related distress and pain perceptions in a sample of patients with chronic tinnitus.

METHODS

N = 1238 patients with chronic tinnitus provided pre- and post-treatment ratings of tinnitus-related distress and affective or sensory pain perceptions alongside measures of depressive symptoms and perceived stress. Treatment comprised an intensive tinnitus-specific multimodal treatment program. Using serial indirect-effects analyses, we examined association patterns between baseline values and change rates of those variables that were found to respond to treatment.

RESULTS

Small effect sizes emerged for changes in tinnitus-related distress, affective (but not sensory) pain perceptions, depressive symptoms, emotional tension and worry. At pre- or post-treatment respectively, baseline values and change rates intercorrelated. Across timepoints, (1) baseline tinnitus-related distress and affective pain perceptions were positively associated with improvements in tinnitus-related distress, affective pain perceptions and depressive symptoms. (2) Baseline depressive symptoms or emotional tension mediated positive associations between baseline tinnitus-related distress and improvement in affective pain perceptions. (3) Change in depressive symptoms mediated the effect of baseline tinnitus-related distress on change in affective pain perceptions-partly through associated change in emotional tension or worry. Mood-independent aspects of emotional tension were negatively associated with improvement in affective pain perceptions.

CONCLUSIONS

Depressive symptoms, emotional tension and worry emerge as key predictors of treatment response and transdiagnostic treatment targets for alleviating tinnitus-related distress and functionally associated affective pain perceptions.

[Distraction and relaxation training in acute tinnitus : effects of a complement to otorhinolaryngological treatment]

BACKGROUND

We examined whether training conceptualized as a complement to standard medical treatment (ST) for acute tinnitus to promote patients' capacity to distract attention from their tinnitus and to relax (distraction and relaxation training) has a positive effect on tinnitus-specific distress (tinnitus loudness, tinnitus-related distress and disability), as well as on general well-being.

PATIENTS AND METHODS

Study participants comprised 29 patients with tinnitus of maximum 4 weeks' standing (first lifetime tinnitus episode) who were randomized to ST (rheological therapy) or advanced standard treatment (AST) (rheological therapy complemented by distraction and relaxation training).

RESULTS

Tinnitus-specific distress was reduced to a significantly greater extent in the EST group as compared to ST, especially in patients with a striking psychopathology. The improvement in general well-being was comparable in both groups.

CONCLUSION

In acute tinnitus, distraction and relaxation training should be conducted as a complement to standard medical treatment, especially in high-risk patients demonstrating abnormal psychopathological status, since treatment results can be improved in this way.

Cognitive-Behavioural Treatment of Tinnitus in Otosclerosis: A Case Report

Tinnitus is a symptom of ear disease that may cause psychological distress. We report here on the successful treatment of stress-related tinnitus in a patient with otosclerosis (an ear disease). The patient experienced stress-induced attacks during which tinnitus became unbearable. A cognitive-behavioural treatment programme of 10 sessions was given during two weeks. Results assessed at pre-and post-treatment showed decreased annoyance and increased coping with tinnitus. The attacks became less frequent and easier to handle. The results support the application of cognitive-behavioural treatment in cases with difficult tinnitus.

Tinnitus rehabilitation: a mindfulness meditation cognitive behavioural therapy approach

BACKGROUND

Chronic tinnitus is a frequent symptom presentation in clinical practice. No drug treatment to date has shown itself to be effective. The aim of the present study was to investigate the effects of cognitive behavioural therapy and meditation in tinnitus sufferers.

METHODOLOGY

Patients were selected from a dedicated tinnitus clinic in the Welsh Hearing Institute. A waiting list control design was used. Twenty-five chronic tinnitus sufferers were consecutively allocated to two groups, one receiving a cognitive behavioural therapy/meditation intervention of four one hour sessions with the other group waiting three months and subsequently treated in the same way, thereby acting as their own control. The main outcome was measured using the Hallam tinnitus questionnaire. A four to six month follow up was conducted.

RESULTS

These showed significant statistical reductions in tinnitus variables both in the active and also in the control group. Post-therapy, no significant change was found after the waiting list period. The improvement was maintained at the four to six month period.

CONCLUSION

The positive findings give support for the use of cognitive behavioural therapy/meditation for chronic tinnitus sufferers.

Classical Conditioning as the Basis for the Effective Treatment of Tinnitus-Related Distress

In this paper the history of the emergence of psychological treatments based on the scientist-practitioner model, such as cognitive-behavior therapy, is described. This historical perspective serves to highlight the potential underlying theoretical bases of such approaches. It is argued that the behavioral position need not be abandoned in order to justify the use of so-called cognitive approaches. Indeed, the behaviorist position, far from having outlived its usefulness, remains an important explanatory concept of human behavior and emotion. This theoretical position may also hold the key to identifying features which are shared in common by tinnitus retraining therapy and cognitive-behavior therapy, and which might be responsible for the efficacy of these approaches. Studies are required in which the basic mechanisms responsible for individual responses to tinnitus are identified in order to develop better approaches to assist people to cope with tinnitus.

A meta-analytic review of psychological treatments for tinnitus

Meta-analysis is a technique of combining results from different trials in order to obtain estimates of effects across studies. Meta-analysis has, as yet, rarely been used in audiological research. The aim of this paper was to conduct a meta-analysis on psychological treatment of tinnitus. The outcomes of 18 studies, including a total of 24 samples and up to 700 subjects, were included and coded. Included were studies on cognitive/cognitive-behavioural treatment, relaxation, hypnosis, biofeedback, educational sessions and problem-solving. Effect sizes for perceived tinnitus loudness, annoyance, negative affect (e.g. depression) and sleep problems were calculated for randomized controlled studies, pre-post-treatment design studies and follow-up results. Results showed strong to moderate effects on tinnitus annoyance for controlled studies (d = 0.86), pre-post designs (d = 0.5) and at follow-up (d = 0.48). Results on tinnitus loudness were weaker and disappeared at follow-up. Lower effect sizes were also obtained for measures of negative affect and sleep problems. Exploratory analyses revealed that cognitive-behavioural treatments were more effective on ratings of annoyance in the controlled studies. It is concluded that psychological treatment for tinnitus is effective, but that aspects such as depression and sleep problems may need to be targeted in future studies.

A critical analysis of directive counselling as a component of tinnitus retraining therapy

Tinnitus retraining therapy (TRT) has been presented as a new approach to tinnitus management. In this paper a number of theoretical and practical problems with TRT are identified. These problems relate to the distinction between directive counselling and cognitive therapy, the adequacy of the cognitive therapy components, the nature of the outcome data which have been presented to date, the theoretical basis for the treatment, and the conceptual clarity of terms such as perception, attention and coping. The stated goal of removal of the perception of tinnitus may lead to confusion about the likely outcome of TRT for most patients. Methodological limitations in the research which has been published to date preclude any claims about the efficacy of TRT at the present time. It is suggested that randomized, controlled studies which include no-treatment and placebo conditions need to be undertaken. Studies are required in which the efficacy of the counselling and white noise components can be clearly isolated. Suggestions are made about the role of psychologists and non-psychologists in the provision of counselling and cognitive therapy services to tinnitus patients.

Tinnitus masking and depression

In this pilot study 30 patients with annoying tinnitus completed tinnitus matching and the Beck Depression Inventory (BDI). A cluster analysis revealed three clusters of patients. Cluster one had relatively low depression and average results on tinnitus parameters. Cluster two displayed high depression scores and lower results on tinnitus parameters. The last small cluster had high depression scores and high results on tinnitus and hearing parameters. A curvilinear regression showed a U-shaped relation between the BDI and minimal masking level. The results are interpreted according to a diathesis stress model, in which a vulnerable person might develop tinnitus distress following a comparatively low degree of tinnitus and a more stress-tolerant person might bear higher degrees of tinnitus before seeking help. As a conclusion this may have implications for what treatment to recommend and most certainly should be accounted for in the assessment of patients.