Bimodal Therapy for Chronic Subjective Tinnitus: A Randomized Controlled Trial of EMDR and TRT Versus CBT and TRT

Tine Roanna Luyten, Laure Jacquemin, Nancy Van Looveren, Frank Declau, Erik Fransen, Emilie Cardon, Marc De Bodt, Vedat Topsakal, Paul Van de Heyning, Vincent Van Rompaey, Annick Gilles, Tine Roanna Luyten, Laure Jacquemin, Nancy Van Looveren, Frank Declau, Erik Fransen, Emilie Cardon, Marc De Bodt, Vedat Topsakal, Paul Van de Heyning, Vincent Van Rompaey, Annick Gilles

Abstract

Introduction: To date, guidelines recommend the use of a stepped care approach to treat tinnitus. The current clinical management of tinnitus frequently consists of audiologic interventions and tinnitus retraining therapy (TRT) or cognitive behavioral therapy (CBT). Due to the high heterogeneity of the tinnitus population and comorbidity of tinnitus with insomnia, anxiety, and depression, these interventions may not be sufficient for every patient. The current study aims to determine whether a bimodal therapy for chronic, subjective tinnitus consisting of the combination of TRT and eye movement desensitization reprocessing (EMDR) results in a clinically significant different efficacy in comparison with the prevailing bimodal TRT and CBT therapy.

Methods: Patients were randomized in two treatment groups. The experimental group received the bimodal therapy TRT/EMDR and the active control group received the bimodal therapy TRT/CBT. Evaluations took place at baseline (T0), at the end of the treatment (T1), and 3 months after therapy (T2). The tinnitus functional index (TFI) was used as primary outcome measurement. Secondary outcome measurements were the visual analog scale of tinnitus loudness (VASLoudness), tinnitus questionnaire (TQ), hospital anxiety and depression scale (HADS), hyperacusis questionnaire (HQ), global perceived effect (GPE), and psychoacoustic measurements.

Findings: The TFI showed clinically significant improvement in both bimodal therapies (mean decrease 15.1 in TRT/CBT; p < 0.001 vs. 16.2 in TRT/EMDR; p < 0.001). The total score on the TQ, HADS, HQ, and VASLoudness all demonstrated significant decrease after treatment and follow-up (p < 0.001) in the experimental and the active control group. GPE-measurements revealed that more than 80% (i.e., 84% in TRT/CBT vs. 80% in TRT/EMDR) of the patients experienced substantial improvement of tinnitus at follow up. Treatment outcome remained stable after 3 month follow-up and no adverse events were observed.

Conclusion: Both psychotherapeutic protocols result in a clinically significant improvement for patients with chronic subjective tinnitus. No significant different efficacy was found for the TRT/EMDR treatment compared to the combination of TRT and CBT.

Clinical trial registration: ClinicalTrials.gov, ID: NCT03114878. April 14, 2017.

Keywords: bimodal therapy; chronic subjective tinnitus; cognitive behavioral therapy; eye movement desensitization and reprocessing; psychotherapy; tinnitus retraining therapy.

Copyright © 2020 Luyten, Jacquemin, Van Looveren, Declau, Fransen, Cardon, De Bodt, Topsakal, Van de Heyning, Van Rompaey and Gilles.

Figures

FIGURE 1
FIGURE 1
Study design. A total of 89 participants were divided into two treatment groups: TRT/CBT (n = 43) or TRT/EMDR (n = 46). Each group received five sessions of TRT and five sessions of either CBT or EMDR, with one session each week. Psychoacoustic measurements and questionnaires were part of the assessment performed at pre-therapy (T0), post-therapy (T1), and follow-up (T2) (CBT, cognitive behavioral therapy; EMDR, eye movement desensitization and reprocessing; TRT, tinnitus retraining therapy).
FIGURE 2
FIGURE 2
Consort flow diagram. Trial profile of the 166 patients who were screened for eligibility. A total of 89 patients completed the study. (TRT, tinnitus retraining therapy; CBT, cognitive behavioral therapy; EMDR, eye movement desensitization and reprocessing; HADS, hospital anxiety and depression scale).
FIGURE 3
FIGURE 3
Total TFI scores by therapy group and time period. Error bars representing 95% CI interval.
FIGURE 4
FIGURE 4
Overview of mean decrease at follow up on all TFI subscales for both treatment groups indicating the cut-off of a decrease of 13 points as marker for Clinically Significant Improvement (CSI). TRT/EMDR treatment group presented in dark blue bars and TRT/CBT treatment group in red bars.
FIGURE 5
FIGURE 5
Total TQ scores by therapy group and time period. Error bars representing 95% CI interval.
FIGURE 6
FIGURE 6
(A) Mean of total fear scores by therapy group and time period. (B) Mean of total depression scores by therapy group and time period. (C) Mean of total HQ scores by therapy group and time period. (D) Mean of total VAS scores of tinnitus loudness by therapy group and time period. Error bars representing 95% CI interval.

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