The value of Eye Movement Desensitization Reprocessing in the treatment of tinnitus: study protocol for a randomized controlled trial

Tine Luyten, Paul Van de Heyning, Laure Jacquemin, Nancy Van Looveren, Frank Declau, Erik Fransen, Annick Gilles, Tine Luyten, Paul Van de Heyning, Laure Jacquemin, Nancy Van Looveren, Frank Declau, Erik Fransen, Annick Gilles

Abstract

Background: Patients suffering from chronic, subjective tinnitus are on a quest to find a cure or any form of alleviation for their persistent complaint. Current recommended therapy forms provide psychotherapeutic interventions that are intended to train the patient how to deal with the tinnitus sound. Pharmaceutical managements are used to reduce secondary effects of the tinnitus sound such as sleep deprivation, emotional and concentration difficulties, but these treatments do not cure the tinnitus. Recent studies have shown that Tinnitus Retraining Therapy (TRT) significantly improves the quality of life for tinnitus patients. Furthermore, several studies have reported that cognitive behavioral therapy (CBT) relieves a substantial amount of distress by changing dysfunctional cognitions. However, when the tinnitus causes great interference with daily functioning, these treatment methods are not always sufficiently effective. Recent insights show that Eye Movement Desensitization Reprocessing (EMDR) is a highly effective therapy for medically unexplained symptoms such as chronic pain and phantom pain. In scientific research, tinnitus is compared to phantom limb pain. Starting from tinnitus as a phantom percept we therefore aim to demonstrate that the operating mechanisms of EMDR may also be an effective treatment method for patients with subjective tinnitus. The aim of this randomized controlled study with blind evaluator is to examine the effect of EMDR compared to CBT in chronic tinnitus patients. To our knowledge, there are no other studies that evaluate both methods simultaneously.

Methods/design: A total of 166 patients with subjective, chronic, non-pulsatile tinnitus will be randomized in two treatment groups: TRT + CBT versus TRT + EMDR. The experimental group will receive the bimodal therapy TRT/EMDR and the active control group will receive the bimodal therapy TRT/CBT. Evaluations will take place at baseline before therapy, at the end of the treatment and 3 months after therapy. The score on the Tinnitus Functional Index (TFI) will be used as the primary outcome measurement. Secondary outcome measurements are the Visual Analogue Scale of Loudness (VAS), Tinnitus Questionnaire (TQ), Hospital Anxiety and Depression Scale (HADS), Hyperacusis Questionnaire (HQ), psychoacoustic measurements and event-related potentials (ERP).

Discussion: The objective is to evaluate whether the bimodal therapy TRT and EMDR can provide faster and/or more relief from the annoyance experienced in chronic tinnitus patients' daily lives compared to the bimodal therapy TRT and CBT. So far there has been no prospective, randomized controlled, clinical trial with blind evaluator that compares CBT and EMDR as a treatment for tinnitus.

Trial registration: ClinicalTrials.gov, ID: NCT03114878 . April 14, 2017.

Keywords: Chronic tinnitus; Cognitive behavioral therapy; Event-related potentials; Eye movement desensitization reprocessing; Tinnitus retraining therapy.

Conflict of interest statement

Authors’ information

Tine Luyten is a clinical psychologist specialized in tinnitus and hyperacusis. She is a licensed psychotherapist in cognitive and behavioural therapy and client-centered, experiential therapy. Currently she is combining therapeutic work in her private practice with a PhD at the Faculty of Medicine and Health Sciences of the University of Antwerp and University Department of Otorhinolaryngology and Head and Neck Surgery in the Antwerp University Hospital in Belgium.

Ethics approval and consent to participate

Written consent will be obtained from every patient. The Ethical Committee of the Antwerp University Hospital approved the study protocol on 17 October 2016 with protocol number EC UZA 16/35/360.

Consent for publication

Not applicable.

Competing interests

None of the authors has any financial or other competing interest. The EyeScan 4000 was financed by VLAIO through an applied research grant. There are no competing interests between the funding organization and the manufacturer of the device.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Consolidated Standards of Reporting Trials (CONSORT) study flow diagram. TRT Tinnitus Retraining Therapy, CBT Cognitive Behavioural Therapy, EMDR Eye Movement Desensitization Reprocessing
Fig. 2
Fig. 2
Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guideline schedule of enrollment, interventions and assessments for both intervention groups

References

    1. De Ridder D, Elgoyhen AB, Romo R, Langguth B. Phantom percepts: tinnitus and pain as persisting aversive memory networks. Proc Natl Acad Sci U S A. 2011;108:8075–8080. doi: 10.1073/pnas.1018466108.
    1. Baguley D, McFerran D, Hall D. Tinnitus. Lancet. 2013;382:1600–1607. doi: 10.1016/S0140-6736(13)60142-7.
    1. Langguth B, Kreuzer PM, Kleinjung T, De Ridder D. Tinnitus: causes and clinical management. Lancet Neurol. 2013;12:920–930. doi: 10.1016/S1474-4422(13)70160-1.
    1. Van de Heyning P, Gilles A, Rabau S, Van Rompaey V. Subjective tinnitus assessment and treatment in clinical practice: the necessity of personalized medicine. Curr Opin Otolaryngol Head Neck Surg. 2015;23:369–375. doi: 10.1097/MOO.0000000000000183.
    1. Shi Y, Robb MJ, Michaelides EM. Medical management of tinnitus: role of the physician. J Am Acad Audiol. 2014;25:23–28. doi: 10.3766/jaaa.25.1.3.
    1. Tunkel DE, Bauer CA, Sun GH, et al. Clinical practice guideline: tinnitus. Otolaryngol Head Neck Surg. 2014;151:S1–S40. doi: 10.1177/0194599814545325.
    1. Cima RF, Maes IH, Joore MA, et al. Specialised treatment based on cognitive behaviour therapy versus usual care for tinnitus: a randomised controlled trial. Lancet. 2012;379:1951–1959. doi: 10.1016/S0140-6736(12)60469-3.
    1. de Roos C, Veenstra AC, de Jongh A, et al. Treatment of chronic phantom limb pain using a trauma-focused psychological approach. Pain Res Manag. 2010;15:65–71. doi: 10.1155/2010/981634.
    1. van Rood YR, de Roos C. EMDR in the treatment of medically unexplained symptoms: a systematic review. J EMDR Pract Res. 2009;3:248–263. doi: 10.1891/1933-3196.3.4.248.
    1. Iranshahr I. The effect of eye movement desensitization and reprocessing on phantom limb pain in patients with amputation. Life Sci J. 2014;11:519–22.
    1. Rostaminejad A, Behnammoghadam M, Rostaminejad M, Behnammoghadam Z, Bashti S. Efficacy of eye movement desensitization and reprocessing on the phantom limb pain of patients with amputations within a 24-month follow-up. Int J Rehabil Res. 2017;40:209–214. doi: 10.1097/MRR.0000000000000227.
    1. Wilensky M. Eye movement desensitization and reprocessing (EMDR) as a treatment for phantom limb pain. J Brief Ther. 2006;5:31–44.
    1. Shapiro F. Eye movement desensitization and reprocessing (EMDR): basic principles, protocols, and procedures. New York: Guilford Press; 2001.
    1. Vanneste S, De Ridder D. The auditory and non-auditory brain areas involved in tinnitus. An emergent property of multiple parallel overlapping subnetworks. Front Syst Neurosci. 2012;6:31. doi: 10.3389/fnsys.2012.00031.
    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. Salvi RJ, Wang J, Ding D. Auditory plasticity and hyperactivity following cochlear damage. Hear Res. 2000;147:261–274. doi: 10.1016/S0378-5955(00)00136-2.
    1. Kaltenbach JA, Afman CE. Hyperactivity in the dorsal cochlear nucleus after intense sound exposure and its resemblance to tone-evoked activity: a physiological model for tinnitus. Hear Res. 2000;140:165–172. doi: 10.1016/S0378-5955(99)00197-5.
    1. Muhlnickel W, Elbert T, Taub E, Flor H. Reorganization of auditory cortex in tinnitus. Proc Natl Acad Sci U S A. 1998;95:10340–10343. doi: 10.1073/pnas.95.17.10340.
    1. Kaltenbach JA, Zhang J, Afman CE. Plasticity of spontaneous neural activity in the dorsal cochlear nucleus after intense sound exposure. Hear Res. 2000;147:282–292. doi: 10.1016/S0378-5955(00)00138-6.
    1. Andersson G, Lyttkens L, Hirvela C, Furmark T, Tillfors M, Fredrikson M. Regional cerebral blood flow during tinnitus: a PET case study with lidocaine and auditory stimulation. Acta Otolaryngol. 2000;120:967–972. doi: 10.1080/00016480050218717.
    1. Mirz F, Gjedde A, Sodkilde-Jrgensen H, Pedersen CB. Functional brain imaging of tinnitus-like perception induced by aversive auditory stimuli. Neuroreport. 2000;11:633–637. doi: 10.1097/00001756-200002280-00039.
    1. Schlee W, Hartmann T, Langguth B, Weisz N. Abnormal resting-state cortical coupling in chronic tinnitus. BMC Neurosci. 2009;10:11. doi: 10.1186/1471-2202-10-11.
    1. Herkt D, Tumani V, Grön G, Kammer T, Hofmann A, Abler B. Facilitating access to emotions: neural signature of EMDR stimulation. PLoS One. 2014;9:e106350. doi: 10.1371/journal.pone.0106350.
    1. Boukezzi S, El Khoury-Malhame M, Auzias G, et al. Grey matter density changes of structures involved in Posttraumatic Stress Disorder (PTSD) after recovery following Eye Movement Desensitization and Reprocessing (EMDR) therapy. Psychiatry Res Neuroimaging. 2017;266:146–152. doi: 10.1016/j.pscychresns.2017.06.009.
    1. Plassmann R. Im eigenen Rhythmus. Gießen: Psychosozial-Verlag; 2009.
    1. Hochstenbach-Nederpel L. Exploring EMDR-therapy and tinnitus. . 2015. Accessed 7 Jan 2016.
    1. Jastreboff PJ, Jastreboff MM. Tinnitus Retraining Therapy (TRT) as a method for treatment of tinnitus and hyperacusis patients. J Am Acad Audiol. 2000;11:162–177.
    1. Henry J, Trune D, Robb M, Jastreboff P. Tinnitus retraining therapy: patient counseling guide. San Diego: Plural; 2007.
    1. Butler AC, Chapman JE, Forman EM, Beck AT. The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev. 2006;26:17–31. doi: 10.1016/j.cpr.2005.07.003.
    1. Aazh H, Moore BC, Lammaing K, Cropley M. Tinnitus and hyperacusis therapy in a UK National Health Service audiology department: patients’ evaluations of the effectiveness of treatments. Int J Audiol. 2016;55:514–522. doi: 10.1080/14992027.2016.1178400.
    1. Shapiro F. Eye Movement Desensitization and Reprocessing (EMDR) and the anxiety disorders: clinical and research implications of an integrated psychotherapy treatment. J Anxiety Disord. 1999;13:35–67. doi: 10.1016/S0887-6185(98)00038-3.
    1. Solomon RM, Shapiro F. EMDR and the adaptive information processing modelpotential mechanisms of change. J EMDR Pract Res. 2008;2:315–325. doi: 10.1891/1933-3196.2.4.315.
    1. Schneider J, Hofmann A, Rost C, Shapiro F. EMDR in the treatment of chronic phantom limb pain. Pain Med. 2007;9:76–82. doi: 10.1111/j.1526-4637.2007.00299.x.
    1. Shapiro F. EMDR, adaptive information processing, and case conceptualization. J EMDR Pract Res. 2007;1:68–87. doi: 10.1891/1933-3196.1.2.68.
    1. Meikle MB, Henry JA, Griest SE, et al. The Tinnitus Functional Index: development of a new clinical measure for chronic, intrusive tinnitus. Ear Hear. 2012;33:153–176. doi: 10.1097/AUD.0b013e31822f67c0.
    1. Rabau S, Wouters K, Van de Heyning P. Validation and translation of the Dutch Tinnitus Functional Index. B-ENT. 2014;10:251–258.
    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. Spinhoven P, Ormel J, Sloekers P, Kempen G, Speckens A, Van Hemert A. A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychol Med. 1997;27:363–370. doi: 10.1017/S0033291796004382.
    1. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67:361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x.
    1. Khalfa S, Dubal S, Veuillet E, Perez-Diaz F, Jouvent R, Collet L. Psychometric normalization of a hyperacusis questionnaire. ORL J Otorhinolaryngol Relat Spec. 2002;64:436–442. doi: 10.1159/000067570.
    1. van Wieringen A, Wouters J. LIST and LINT: sentences and numbers for quantifying speech understanding in severely impaired listeners for Flanders and the Netherlands. Int J Audiol. 2008;47:348–355. doi: 10.1080/14992020801895144.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever