Psychotherapy Quiets Concerns Over Ringing in the
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!
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
"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
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
"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.
The Cochrane Collaboration is an international nonprofit, independent
organization that produces and disseminates systematic reviews of health
care interventions and promotes the search for evidence in the form of
clinical trials and other studies of interventions. Visit http://www.cochrane.org
for more information.