By Richard S. Tyler, PhD
Dr. Tyler is a professor of otolaryngology–head and neck surgery and of communication sciences and disorders at the University of Iowa. He has hosted an annual Management of the Tinnitus Patient Course for 21 years (June 13-14, 2014; http://bit.ly/TinnitusConf) and is the editor of Tinnitus Handbook (2000), Tinnitus Treatment: Clinical Protocols (2006), and The Consumer Handbook on Tinnitus (2008).
It is encouraging that there is now great attention on providing effective tinnitus treatments. Tinnitus can cause grave consequences, affecting the primary functions of emotions, hearing, concentration, and sleep.
Numerous strategies have evolved since the first protocols were introduced in the 1980s. (Hallam RS. Living with Tinnitus: Dealing with the Ringing in Your Ears. Wellingborough, England: Thorsons; 1989.)
Although it was first shown that cognitive behavioral therapy (CBT) was an effective tinnitus treatment, several in the field realized that it was not enough. For example, Anne-Mette Mohr and Uno Hedelund highlighted the importance of helping patients accept their tinnitus. (Tinnitus person-centered therapy. In: Tyler RS, ed. Tinnitus Treatment: Clinical Protocols. New York, NY: Thieme Medical Publishers; 2006.)
Several, perhaps hundreds, of psychological therapies have been developed for dealing with emotions—often those related to pain. All of these approaches can be adapted to help tinnitus patients.
Mindfulness evolved from Buddhist philosophy. In 1979, Jon Kabat-Zinn developed a Mindfulness-Based Stress Reduction program that forms the foundation for Mindfulness-Based Tinnitus Stress Reduction (MBTSR).
Jennifer Gans, PsyD, an experienced mindfulness teacher and clinical psychologist, has adapted mindfulness for tinnitus therapy. Her approach includes teaching skills to train the mind to bring attention “back to the present … whenever the mind starts to dwell in the past or future.”
The practice includes sitting meditation, body awareness, mindful movement, and mindfulness in day-to-day living.
The MBTSR program was expanded to include working with sleep issues, depression, anxiety, stress, tinnitus education, and life with tinnitus. Participants are encouraged to observe the tinnitus sensation with “affectionate curiosity instead of reacting in habitual ways,” and to use their own natural internal resources for healing.
Dr. Gans and colleagues designed this pilot study to explore whether their approach had potential and deserved further investigation.
They made their work challenging by selecting patients who had previously received a 90-minute tinnitus counseling session, during which the provider outlines possible causes, ways to minimize stress, and current management and treatment options.
The mindfulness procedure included an eight-week group session that met for 150 minutes once a week, a one-day retreat, additional readings, and home-practice meditations guided by audio recordings.
The eight patients who completed the study showed a decrement on the Tinnitus Handicap Inventory (3-label category scale).
Changes on a quality-of-life scale were not as dramatic. However, quality-of-life questions are less likely to be influenced by a decrease in tinnitus because they are also affected by family, social, and work issues.
In the manuscript by Dr. Gans et al, the protocol is described in detail, and the review of the literature is comprehensive.
BEYOND THE BASICS
The authors emphasize that this is a pilot study, acknowledging that the lack of a control group prevents any firm conclusions.
They suggest, for example, that just being in a group is often helpful. (Newman CW, Sandridge SA. Incorporating group and individual sessions into a tinnitus management clinic. In: Tyler RS, ed. Tinnitus Treatment: Clinical Protocols. New York, NY: Thieme Medical Publishers; 2006.)
Many patients will certainly benefit from this comprehensive mindfulness procedure. Of course, there are other psychological therapies—alleviation therapy, coping effectiveness training, patient-centered therapy, acceptance therapy—all of which can be applied to tinnitus patients to help them cope with their emotions.
Many advocates of CBT have changed their definition of the therapy to include these other approaches. In addition, general relaxation/meditation procedures, such as yoga, progressive muscle relaxation, Tai Chi, and Qigong, can also be adapted specifically for tinnitus patients.
The mindfulness pilot study is important because it once again emphasizes how critical it is to provide more than just basic information to concerned tinnitus patients. There is so much to offer our patients now.
Author’s note: Dr. Gans will be a featured speaker at the 22nd Annual Management of the Tinnitus Patient Course June 13-14 in Iowa City, IA: http://bit.ly/TinnitusConf.