Mindfulness-and body-psychotherapy-based group treatment of chronic tinnitus: a randomized controlled pilot study

Peter M Kreuzer, Monika Goetz, Maria Holl, Martin Schecklmann, Michael Landgrebe, Susanne Staudinger, Berthold Langguth, Peter M Kreuzer, Monika Goetz, Maria Holl, Martin Schecklmann, Michael Landgrebe, Susanne Staudinger, Berthold Langguth

Abstract

Background: Tinnitus, the perception of sound in absence of an external acoustic source, impairs the quality of life in 2% of the population. Since in most cases causal treatment is not possible, the majority of therapeutic attempts aim at developing and strengthening individual coping and habituation strategies. Therapeutic interventions that incorporate training in mindfulness meditation have become increasingly popular in the treatment of stress-related disorders. Here we conducted a randomized, controlled clinical study to investigate the efficacy of a specific mindfulness- and body-psychotherapy based program in patients suffering from chronic tinnitus.

Methods: Thirty-six patients were enrolled in this pilot study. The treatment was specifically developed for tinnitus patients and is based on mindfulness and body psychotherapy. Treatment was performed as group therapy at two training weekends that were separated by an interval of 7 weeks (eleven hours/weekend) and in four further two-hour sessions (week 2, 9, 18 and 22). Patients were randomized to receive treatment either immediately or after waiting time, which served as a control condition. The primary study outcome was the change in tinnitus complaints as measured by the German Version of the Tinnitus Questionnaire (TQ).

Results: ANOVA testing for the primary outcome showed a significant interaction effect time by group (F = 7.4; df = 1,33; p = 0.010). Post hoc t-tests indicated an amelioration of TQ scores from baseline to week 9 in both groups (intervention group: t = 6.2; df = 17; p < 0.001; control group: t = 2.5; df = 16; p = 0.023), but the intervention group improved more than the control group. Groups differed at week 7 and 9, but not at week 24 as far as the TQ score was concerned.

Conclusions: Our results suggest that this mindfulness- and body-psychotherapy-based approach is feasible in the treatment of tinnitus and merits further evaluation in clinical studies with larger sample sizes.The study is registered with clinicaltrials.gov (NCT01540357).

Figures

Figure 1
Figure 1
Structure and schedule of the study.
Figure 2
Figure 2
Tinnitus questionnaire.

References

    1. Andersson G, Baguley D, McKenna L. Tinnitus: A Multidisciplinary Approach. London: Whurr; 2005.
    1. Cronlein T, Langguth B, Geisler P, Hajak G. Tinnitus and insomnia. Prog Brain Res. 2007;166:227–233.
    1. Langguth B, Landgrebe M, Kleinjung T, Sand GP, Hajak G. Tinnitus and depression. World J Biol Psychiatry. 2011;12(7):489–500. doi: 10.3109/15622975.2011.575178. Epub 2011 May 13.
    1. Langguth B. A review of tinnitus symptoms beyond ‘ringing in the ears’: a call to action. Curr Med Res Opin. 2011;27:1635–1643. doi: 10.1185/03007995.2011.595781.
    1. Krog NH, Engdahl B, Tambs K. The association between tinnitus and mental health in a general population sample: results from the HUNT Study. J Psychosom Res. 2010;69(3):289–298. doi: 10.1016/j.jpsychores.2010.03.008. Epub 2010 Apr 21.
    1. Hoare DJ, Kowalkowski VL, Kang S, Hall DA. Systematic review and meta-analyses of randomized controlled trials examining tinnitus management. Laryngoscope. 2011;121:1555–1564. doi: 10.1002/lary.21825.
    1. Hesser H, Westin V, Hayes SC, Andersson G. Clients’ in-session acceptance and cognitive defusion behaviors in acceptance-based treatment of tinnitus distress. Behav Res Ther. 2009;47:523–528. doi: 10.1016/j.brat.2009.02.002.
    1. Martinez-Devesa P, Perera R, Theodoulou M, Waddell A. Cognitive behavioural therapy for tinnitus. Cochrane Database Syst Rev. 2010;8(9):CD005233.
    1. Kabat-Zinn J. An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. Gen Hosp Psychiatry. 1982;4:33–47. doi: 10.1016/0163-8343(82)90026-3.
    1. Bohlmeijer E, Prenger R, Taal E, Cuijpers P. The effects of mindfulness-based stress reduction therapy on mental health of adults with a chronic medical disease: a meta-analysis. J Psychosom Res. 2010;68:539–544. doi: 10.1016/j.jpsychores.2009.10.005.
    1. Chiesa A, Serretti A. Mindfulness-based stress reduction for stress management in healthy people: a review and meta-analysis. J Altern Complement Med. 2009;15:593–600. doi: 10.1089/acm.2008.0495.
    1. Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. J Consult Clin Psychol. 2010;78:169–183.
    1. Morone NE, Greco CM, Weiner DK. Mindfulness meditation for the treatment of chronic low back pain in older adults: a randomized controlled pilot study. Pain. 2008;134:310–319. doi: 10.1016/j.pain.2007.04.038.
    1. Wong SY, Chan FW, Wong RL, Chu MC, Kitty Lam YY, Mercer SW, Ma SH. Comparing the effectiveness of mindfulness-based stress reduction and multidisciplinary intervention programs for chronic pain: a randomized comparative trial. Clin J Pain. 2011;27:724–734. doi: 10.1097/AJP.0b013e3182183c6e.
    1. Sadlier M, Stephens SD, Kennedy V. Tinnitus rehabilitation: a mindfulness meditation cognitive behavioural therapy approach. J Laryngol Otol. 2008;122:31–37.
    1. Philippot P, Nef F, Clauw L, Romree M, Segal Z. A randomized controlled trial of mindfulness-based cognitive therapy for treating tinnitus. Clin Psychol Psychother. 2012;19(5):411–419. doi: 10.1002/cpp.756. Epub 2011 May 12.
    1. Hesser H, Gustafsson T, Lunden C, Henrikson O, Fattahi K, Johnsson E, Westin VZ, Carlbring P, Maki-Torkko E, Kaldo V, Andersson G. A randomized controlled trial of internet-delivered cognitive behavior therapy and acceptance and commitment therapy in the treatment of tinnitus. J Consult Clin Psychol. 2012;80:649–661.
    1. Westin VZ, Schulin M, Hesser H, Karlsson M, Noe RZ, Olofsson U, Stalby M, Wisung G, Andersson G. Acceptance and commitment therapy versus tinnitus retraining therapy in the treatment of tinnitus: a randomised controlled trial. Behav Res Ther. 2011;49:737–747. doi: 10.1016/j.brat.2011.08.001.
    1. Holl M. Die Tinnitus-Atemtherapie: So gehen Sie aktiv gegen Ihr Ohrgeräusch vor. Hannover: Schluetersche; 2011.
    1. Kleinjung T, Fischer B, Langguth B, Sand P, Hajak G, Dvorakova J, Eichhammer P. Validation of the german-version tinnitus handicap inventory (THI) Psychiatr Prax. 2007;34:140–142. doi: 10.1055/s-2006-940218.
    1. Goebel G, Hiller W. The tinnitus questionnaire. A standard instrument for grading the degree of tinnitus. Results of a multicenter study with the tinnitus questionnaire. HNO. 1994;42:166–172.
    1. Beck AT, Steer RA. Internal consistencies of the original and revised beck depression inventory. J Clin Psychol. 1984;40:1365–1367. doi: 10.1002/1097-4679(198411)40:6<1365::AID-JCLP2270400615>;2-D.
    1. Landgrebe M, Zeman F, Koller M, Eberl Y, Mohr M, Reiter J, Staudinger S, Hajak G, Langguth B. The tinnitus research initiative (TRI) database: a new approach for delineation of tinnitus subtypes and generation of predictors for treatment outcome. BMC Med Inform Decis Mak. 2010;10:42. doi: 10.1186/1472-6947-10-42.
    1. Huck SW, McLean RA. Using a repeated measures ANOVA to analyze the data from a pretest-posttest design: a potentially confusing task. Psychol Bull. 1975;82:511–518.
    1. Van Breukelen GJ. ANCOVA versus change from baseline: more power in randomized studies, more bias in nonrandomized studies [corrected] J Clin Epidemiol. 2006;59:920–925. doi: 10.1016/j.jclinepi.2006.02.007.
    1. Vickers AJ, Altman DG. Statistics notes: analysing controlled trials with baseline and follow up measurements. BMJ. 2001;323:1123–1124. doi: 10.1136/bmj.323.7321.1123.
    1. Kleinjung T, Eichhammer P, Landgrebe M, Sand P, Hajak G, Steffens T, Strutz J, Langguth B. Combined temporal and prefrontal transcranial magnetic stimulation for tinnitus treatment: a pilot study. Otolaryngol Head Neck Surg. 2008;138:497–501. doi: 10.1016/j.otohns.2007.12.022.
    1. Biesinger E, Kipman U, Schatz S, Langguth B. Qigong for the treatment of tinnitus: a prospective randomized controlled study. J Psychosom Res. 2010;69:299–304. doi: 10.1016/j.jpsychores.2010.04.013.
    1. Veehof MM, Oskam MJ, Schreurs KM, Bohlmeijer ET. Acceptance-based interventions for the treatment of chronic pain: a systematic review and meta-analysis. Pain. 2011;152:533–542. doi: 10.1016/j.pain.2010.11.002.
    1. Chiesa A, Serretti A. Mindfulness based cognitive therapy for psychiatric disorders: a systematic review and meta-analysis. Psychiatry Res. 2011;187:441–453. doi: 10.1016/j.psychres.2010.08.011.
    1. Kerr CE, Jones SR, Wan Q, Pritchett DL, Wasserman RH, Wexler A, Villanueva JJ, Shaw JR, Lazar SW, Kaptchuk TJ. et al.Effects of mindfulness meditation training on anticipatory alpha modulation in primary somatosensory cortex. Brain Res Bull. 2011;85:96–103. doi: 10.1016/j.brainresbull.2011.03.026.
    1. Weisz N, Dohrmann K, Elbert T. The relevance of spontaneous activity for the coding of the tinnitus sensation. Prog Brain Res. 2007;166:61–70.
    1. Dohrmann K, Weisz N, Schlee W, Hartmann T, Elbert T. Neurofeedback for treating tinnitus. Prog Brain Res. 2007;166:473–485.
    1. Weisz N, Langguth B. Cortical plasticity and changes in tinnitus: treatment options. HNO. 2010;58:983–989. doi: 10.1007/s00106-010-2178-7.
    1. Landgrebe M, Langguth B, Rosengarth K, Braun S, Koch A, Kleinjung T, May A, de Ridder D, Hajak G. Structural brain changes in tinnitus: grey matter decrease in auditory and non-auditory brain areas. NeuroImage. 2009;46:213–218. doi: 10.1016/j.neuroimage.2009.01.069.
    1. Vanneste S, Plazier M, der Loo E, de Heyning PV, Congedo M, De Ridder D. The neural correlates of tinnitus-related distress. NeuroImage. 2010;52:470–480. doi: 10.1016/j.neuroimage.2010.04.029.
    1. Giraud AL, Chery-Croze S, Fischer G, Fischer C, Vighetto A, Gregoire MC, Lavenne F, Collet L. A selective imaging of tinnitus. Neuroreport. 1999;10:1–5. doi: 10.1097/00001756-199901180-00001.
    1. Lanting CP, de Kleine E, van Dijk P. Neural activity underlying tinnitus generation: results from PET and fMRI. Hear Res. 2009;255:1–13. doi: 10.1016/j.heares.2009.06.009.
    1. Holzel BK, Ott U, Hempel H, Hackl A, Wolf K, Stark R, Vaitl D. Differential engagement of anterior cingulate and adjacent medial frontal cortex in adept meditators and non-meditators. Neurosci Lett. 2007;421:16–21. doi: 10.1016/j.neulet.2007.04.074.
    1. Tyler RS, Oleson J, Noble W, Coelho C, Ji H. Clinical trials for tinnitus: study populations, designs, measurement variables, and data analysis. Prog Brain Res. 2007;166:499–509.

Source: PubMed

3
구독하다