Psychotherapy Quiets Concerns Over Ringing in the Ears

Editor: There are a variety of treatments available for tinnitus sufferers, and many of them seem to be effective for some folks, but not all. But this is the first time I've someone advocate the use of psychotherapy as a tinnitus treatment!

~~~~~~~~~~~~~~~~~

January 2007

Psychotherapy may help tinnitus suffers cope with the life disturbances that sometimes accompany their condition, according to a new review of studies.

Tinnitus is a sensation of ringing or other noise when there is no external cause for the sound. A counseling method called cognitive behavioral therapy or CBT seems to amplify patients' quality of life, even when the volume of the noise remains the same.

"It's a way of working on beliefs and changing psychological responses to tinnitus," said lead reviewer Pablo Martinez-Devesa. "Usually you'd assess the patient's feelings and perceptions of tinnitus, then introduce education on the possible causes. Then, through several sessions, you would try to change the attitudes of patients toward the tinnitus."

The review of six small randomized controlled trials gathered data on 285 patients. The article appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.

Tinnitus affects up to 18 percent of people in industrialized countries, according to the review. The vast majority of people with the condition do not seek treatment but cope with the noise inside their head on their own.

But between 0.5 percent and 3 percent of adults with tinnitus have a chronic condition severe enough to impinge on their life. Among these sufferers, sleep disturbances, anxiety and depression are common.

After participating in CBT, tinnitus sufferers reported greater overall satisfaction with their life, compared to a similar group of patients who did not receive CBT treatment, the Cochrane review found.

Cognitive behavioral therapy is used with good success as a treatment for depression. So Martinez-Devesa and his team thought CBT might lift the mood of tinnitus sufferers. "We were expecting, perhaps, to see a bigger improvement on the symptoms of depression, but we didn't find it," he said. Martinez-Devesa said the collected studies included just a small number of people with severe depression, so it may have been difficult to perceive a change in mood.

CBT also failed to produce significant improvements in the subjective [or perceived] volume of tinnitus, the review found.

Tinnitus researcher Robert Folmer said how people react or deal with the perception of sound is what separates a sufferer from someone who is little bothered by tinnitus. Folmer, an associate professor of otolaryngology at Oregon Health and Science University, was not on the Cochrane review team.

Cognitive behavioral therapy, which helps people with life and coping skills, is widely available throughout the United States, but Folmer suspects that few American practitioners are using CBT to treat tinnitus.

"We refer a lot of people for psychological counseling, including CBT, but the problem is we never know what they are going to get when they go there," Folmer said. "When I say CBT that means something different to everyone. There's a wide range of what that could be."

Martinez-Devesa says gold-standard cognitive behavioral therapy would include patient education about the condition. But Folmer said that even without specific knowledge about tinnitus, a CBT provider can still be helpful.

"Even though a therapist doesn't know anything about tinnitus, if they help the patient with co-symptoms, our studies have shown that the severity of tinnitus goes down, if those other factors improve," he said.

Often, doctors are at a loss for ways to effectively treat chronic tinnitus. In those cases, helping someone with related conditions like anxiety or sleeping problems becomes the best solution, Folmer said.

Martinez-Devesa P, et al. Cognitive behavioural therapy for tinnitus (Review). Cochrane Database of Systematic Reviews 2007, Issue 1.