Mindfulness-Based Cognitive Therapy as a Treatment for Chronic Tinnitus: A Randomized Controlled Trial

Abstract

Background: Tinnitus is experienced by up to 15% of the population and can lead to significant disability and distress. There is rarely a medical or surgical target and psychological therapies are recommended. We investigated whether mindfulness-based cognitive therapy (MBCT) could offer an effective new therapy for tinnitus. Methods: This single-site randomized controlled trial compared MBCT to intensive relaxation training (RT) for chronic, distressing tinnitus in adults. Both treatments involved 8 weekly, 120-min sessions focused on either relaxation (RT) or mindfulness meditation (MBCT). Assessments were completed at baseline and at treatment commencement 8 weeks later. The primary outcomes were tinnitus severity (Tinnitus Questionnaire) and psychological distress (Clinical Outcomes in Routine Evaluation - Non-Risk, CORE-NR), 16 weeks after baseline. The analysis utilized a modified intention-to-treat approach. Results: A total of 75 patients were randomly allocated to MBCT (n = 39) or RT (n = 36). Both groups showed significant reductions in tinnitus severity and loudness, psychological distress, anxiety, depression, and disability. MBCT led to a significantly greater reduction in tinnitus severity than RT, with a mean difference of 6.3 (95% CI 1.3-11.4, p = 0.016). Effects persisted 6 months later, with a mean difference of 7.2 (95% CI 2.1-2.3, p = 0.006) and a standardized effect size of 0.56 (95% CI 0.16-0.96). Treatment was effective regardless of initial tinnitus severity, duration, or hearing loss. Conclusions: MBCT is effective in reducing tinnitus severity in chronic tinnitus patients compared to intensive RT. It also reduces psychological distress and disability. Future studies should explore the generalizability of this approach and how outcome relates to different aspects of the intervention.

A multidisciplinary European guideline for tinnitus: diagnostics, assessment, and treatment

“…Cognitive behavioural theory and treatment have been applied in tinnitus research for decades and the results of the effectiveness of CBT approaches for tinnitus have been shown to vary in decreasing tinnitus severity/distress, tinnitus-related fear, tinnitus disability, and tinnitus-related cognitive problems and in improving daily life functioning [13,120,126,139,141]. Establishing the effectiveness of CBT in tinnitus health care and research is difficult because patients report to suffer in various life domains.…”

“…The approach offers individuals a new way to relate to thoughts that allow them to reduce their tendency to engage in negative and catastrophic thoughts. Mindfulness for tinnitus has been tested in clinical trials with evidence that it is feasible as a treatment for tinnitus [141,197] and may be beneficial in reducing negative emotions, rumination, and psychological difficulties [206].…”

Living with tinnitus and the health care journey: An interpretative phenomenological analysis

“…This idea is supported by some evidence that suggests that tinnitus‐related distress is more closely related to cognitive behavioural mechanisms than the acoustic properties of tinnitus (McKenna et al ., ). Similarly, there is evidence that treatments targeting cognitions, behaviours, and attentional processes (rather than tinnitus itself) can reduce distress and improve quality of life, and mindfulness‐based cognitive therapy (McKenna et al ., ) and cognitive behavioural therapy (Cima et al ., ) are the most effective. Further research should explore why the biopsychosocial model, although part of medical education, is not evident across routine practice for tinnitus patients in the United Kingdom, and why routine medical practice may struggle to respond to tinnitus patients who are severely troubled.…”

“…Hallam, 1996), a 41-item self-report measure, assessed tinnitus distress. Total scores are calculated, and reliable and clinically significant change on the TQ requires a change of at least 11 points (McKenna et al, 2017). The Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) (Evans et al, 2000), a 34-item self-report measure, assessed pan-diagnostic psychological distress.…”

Lifeworld interpretation of tinnitus

“…Cognitive behavioural therapy, mindfulness, and acceptance and commitment therapy have demonstrably reduced tinnitus distress 9,14 . These approaches depend on individualised reinterpretation of bodily signs (tinnitus) and symptoms (bodily markers of stress).…”