TINNITUS & MINDFULNESS: RESEARCH ROUNDUP

Mindfulness used in a tinnitus context was first described by Sadlier et al. (2007). They delivered four, one-hour sessions of conventional CBT and education to 25 tinnitus patients, with mindfulness meditation introduced in the third session. The authors reported significant reductions in tinnitus complaint but mindfulness was only a small part of a multi-component treatment package

In conference proceedings, Mazzolli and colleagues (2010) reported improved ability to relax and control annoying tinnitus, increased periods of tinnitus absence and a change in the EEG patterns of patients after completing a mindfulness based therapy, with a modification of the ratio of alpha to delta waves in favour of the alpha rhythm.

Roland et al. (2015) evaluated the impact of Mindfulness Based Stress Reduction (MBSR) on 13 patients with chronic tinnitus. They observed reductions in the severity of tinnitus and depressive symptoms. They also used fMRI and found that there was increased ‘connectivity’ in cortical attention networks, a potential biomarker of neural networks involved in the maintenance of tinnitus that may be modified by MBSR

Gans et al. (2013) reported a pilot study of an eight week Mindfulness Based Tinnitus Stress Reduction intervention. This was provided to eight participants with chronic tinnitus (present for six months), previously treated with standard care, and without comorbid severe depression or anxiety. A pre- to post- 6 intervention design was used, and standardized questionnaires were completed before and after treatment. Measures assessed psychological state, quality of life, mindfulness, standardized and unstandardized measures of tinnitus complaint. They observed statistically significant improvements on these measures, suggesting that the intervention was beneficial, but the sample size was small and there was no follow-up evaluation

A recent randomized controlled trial (Philippot et al. 2012) compared the effectiveness of MBCT to relaxation training in patients who had experienced tinnitus within the preceding six months and who reported significant impairment and distress relating to tinnitus.

Hesser et al. (2015) report on a crosssectional study showing that acceptance mediates the association between loudness and severity of tinnitus.

Westin et al (2008) reported a longitudinal study that showed acceptance mediated between tinnitus distress at baseline and tinnitus distress, depression, quality of life and anxiety at seven months follow-up.

Other studies describe how efforts to control tinnitus are associated with increased tinnitus-related disability (Hesser et al. 2009), and how avoidance has been associated with anxiety and tinnitus-related distress (Hesser & Andersson 2009).

Mindfulness Based Cognitive Therapy (MBCT) led to significant reductions in tinnitus-related distress and psychological distress in patients with chronic and distressing tinnitus. Changes reflecting reliable improvement were reported by over 40% of the sample at the final week of treatment and this was maintained in the longer-term. As hypothesized, there were significant and reliable reductions in both tinnitus-related distress and global psychological 18 distress. These findings add to growing support for the use of Mindfulness Based Approaches and specifically a standardized MBCT intervention with chronic and distressed tinnitus patients. (McKenna, Marks, & Vogt, F 2018)

REFERENCES

Sadlier, M., Stephens, S. D. G., & Kennedy, V. (2007). Tinnitus rehabilitation: a mindfulness meditation cognitive behavioural approach. The Journal of Laryngology and Otology, 122: 31-7.

Mazzolli, M., Sintoni, K., Stallato, A. et al (2010) Mindfulness-based stress reduction (MBSR) intervention in tinnitus therapy. Symposium at the 4 th International TRI Tinnitus Conference Frontiers in Tinnitus Research.

Roland, L.T., Lenze, E.J., Hardin, F.M., Kallogjeri, D., Nicklaus, J. et al. (2015) Effects of Mindfulness-based Stress Reduction Therapy on Subjective Bother and Neural Connectivity in Chronic Tinnitus. Ototlaryngology – Head and Neck Surgery 152(2): 919 – 926

Gans, J., O’Sullivan, P. & Bircheff, V. (2013) Mindfulness-based Tinnits Stress Reduction Pilot Study: A symptom perception-Shift Program. Mindfulness: DOI 10.1007/s12671-012-0184-4

Philippot, P., Nef, F., Clauw, L., Romrée, M. & Segal, Z. (2012) A randomized controlled trial of Mindfulness-based Cognitive Therapy for treating tinnitus. Clinical Psychology and Psychotherapy 19(5): 411-19

Hesser, H., Bånkestad, E., & Andersson, G. (2015). Acceptance of Tinnitus As an Independent Correlate of Tinnitus Severity. Ear and Hearing, 36(4): e176-e182.

Westin, V.Z., Schulin, M., Hesser, H., Karlsson, M., Olofsson, U. et al., (2011). Acceptance and Commitment Therapy versus Tinnitus Retraining Therapy in the treatment of tinnitus: A randomized controlled trial. Behaviour Research and Therapy 49(11): 737-47

Hesser, H., Westin, V., Hayes, S. C., & Andersson, G. (2009). Clients' insession acceptance and cognitive defusion behaviors in acceptance-based treatment of tinnitus distress. Behaviour Research and Therapy, 47(6): 523- 528

Hesser, H. & Andersson, G. (2009). The role of anxiety sensitivity and behavioural avoidance in tinnitus disability. Int J Audiol. 48(5): 295-9.

McKenna, L, Marks, E & Vogt, F 2018, 'Mindfulness based cognitive therapy for chronic tinnitus: evaluation of benefits in a large sample of patients attending a tinnitus clinic', Ear and Hearing, vol. 39, no. 2, pp. 359 - 366. https://doi.org/10.1097/AUD.0000000000000491