Effects of mindfulness based stress reduction therapy on subjective bother and neural connectivity in chronic tinnitus

Abstract

Objective: To evaluate the impact of a Mindfulness Based Stress Reduction (MBSR) program in patients with chronic bothersome tinnitus on the (1) severity of symptoms of tinnitus and (2) functional connectivity in neural attention networks.

Study design: Open-label interventional pilot study.

Setting: Outpatient academic medical center.

Subjects: A total of 13 adult participants with a median age of 55 years, suffering from bothersome tinnitus.

Methods: An 8-week MBSR program was conducted by a trained MBSR instructor. The primary outcome measure was the difference in patient-reported tinnitus symptoms using the Tinnitus Handicap Index (THI) and Tinnitus Functional Index (TFI) between pre-intervention, post-MBSR, and 4-week post-MBSR assessments. Secondary outcomes included change in measurements of depression, anxiety, mindfulness, and cognitive abilities. Functional connectivity magnetic resonance imaging (MRI) was performed at pre- and post-MBSR intervention time points to serve as a neuroimaging biomarker of critical cortical networks.

Results: Scores on the THI and TFI showed statistically significant and clinically meaningful improvement over the course of the study with a median ΔTHI of -16 and median ΔTFI of -14.8 between baseline and 4-week follow-up scores. Except for depression, there was no significant change in any of the secondary outcome measures. Analysis of the resting state functional connectivity MRI (rs-fcMRI) data showed increased connectivity in the post-MBSR group in attention networks but not the default network.

Conclusion: Participation in an MBSR program is associated with decreased severity in tinnitus symptoms and depression and connectivity changes in neural attention networks. MBSR is a promising treatment option for chronic bothersome tinnitus that is both noninvasive and inexpensive.

Keywords: functional connectivity MRI; neuroplasticity; tinnitus.

© American Academy of Otolaryngology-Head and Neck Surgery Foundation 2015.

Figures

Figure 1

Self reported tinnitus health status. (A) Boxplot indicating median tinnitus functional index (TFI). (B) Boxplot indicating median tinnitus handicap inventory (THI). * indicates p

Figure 2

Functional connectivity for inferior frontal gyrus regions of interest pre- and post- MBSR. For each analysis, the seed region is displayed as a green sphere. Warm colors indicate brain regions that show significant connectivity with the seed region, with the colormap corresponding to the t statistic. The right column shows post > pre functional connectivity data with significant clusters circled in white.

Figure 3

Functional connectivity for left and right anterior operculum regions of interest pre- and post- MBSR. The right panel illustrates significant clusters showing increased connectivity for post-MBSR relative to pre-MBSR.

Figure 4

Functional connectivity for posterior and anterior cingulate regions of interest pre- and post- MBSR. There were no significant differences between pre- and post- MBSR scans.