The Role of Psychology in Managing Tinnitus: A Cognitive Behavioral Approach

 

 Buy Article Permissions and Reprints

ABSTRACT

This article presents an overview of how cognitive behavioral therapy (CBT) is conducted with tinnitus patients. Assessment strategies used in CBT for tinnitus involve structured interviews, daily diary ratings, and validated self-report questionnaires. The treatment includes applied relaxation, imagery and distraction techniques, advice regarding environmental sounds, management of sleep, and cognitive restructuring of thoughts and beliefs associated with tinnitus. Occasionally, hearing tactics and advice regarding hyperacusis are included. The treatment ends with relapse prevention to prepare for fluctuations in distress caused by tinnitus. The effect of psychological treatment according to CBT principles has been investigated in several studies and shows promising results in that annoyance caused by tinnitus is reduced. Most recently, a self-help version has been developed and tested over the Internet. The article ends with a discussion of professional issues, such as who should conduct CBT, and decisions made when referring patients to a psychologist.

REFERENCES

• 1 Fowler E P. The emotional factor in tinnitus aurium.  Laryngoscope . 1948;  58 145-154
  CrossrefPubMedGoogle Scholar
• 2 Andersson G, Lyttkens L. Acupuncture for tinnitus: time to stop?.  Scand Audiol . 1996;  25 273-275
  PubMedGoogle Scholar
• 3 Dobie R A. A review of randomized clinical trials of tinnitus.  Laryngoscope . 1999;  109 1202-1211
  CrossrefPubMedGoogle Scholar
• 4 Andersson G, Lyttkens L. A meta-analytic review of psychological treatments for tinnitus.  Br J Audiol . 1999;  33 201-210
  CrossrefPubMedGoogle Scholar
• 5 Hawton K, Salkovskis P M, Kirk J, Clark D M. Cognitive Behaviour Therapy for Psychiatric Problems.  Oxford: Oxford University Press; 1989
  Google Scholar
• 6 Sweetow R W. The evolution of cognitive-behavioral therapy as an approach to tinnitus management.  International Tinnitus Journal . 1995;  1 61-65
  PubMedGoogle Scholar
• 7 Hallam R S, Rachman S, Hinchcliffe R. Psychological aspects of tinnitus. In: Rachman S, ed. Contributions to Medical Psychology Oxford: Pergamon Press 1984: 31-53
  Google Scholar
• 8 Wilson P H, Henry J, Bowen M, Haralambous G. Tinnitus reaction questionnaire: psychometric properties of a measure of distress associated with tinnitus.  J Speech Hear Res . 1991;  34 197-201
  CrossrefPubMedGoogle Scholar
• 9 Jastreboff M M. Controversies between cognitive therapies and TRT counselling. In: Hazell J, ed. Proceedings of the Sixth International Tinnitus Seminar Cambridge: The Tinnitus and Hyperacusis Centre 1999: 288-291
  Google Scholar
• 10 Tyler R S. Tinnitus disability and handicap questionnaires.  Semin Hear . 1993;  14 377-383
  PubMedGoogle Scholar
• 11 Newman C W, Jacobson G P, Spitzer J B. Development of the tinnitus handicap inventory.  Arch Otolaryngol Head Neck Surg . 1996;  122 143-148
  CrossrefPubMedGoogle Scholar
• 12 Goebel G, Hiller W. Quality management in the therapy of chronic tinnitus. In: Hazell J, ed. Proceedings of the Sixth International Tinnitus Seminar Cambridge: The Tinnitus and Hyperacusis Centre 1999: 357-363
  Google Scholar
• 13 Andersson G, Melin L, Lindberg P, Scott B. Development of a short scale for self-assessment of experiences of hearing impairment: The Hearing Coping Assessment.  Scand Audiol . 1995;  24 I47-154
  PubMedGoogle Scholar
• 14 Beck A T, Ward C H, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression.  Arch Gen Psychiatry . 1961;  4 561-571
  CrossrefPubMedGoogle Scholar
• 15 Spielberger C D, Gorsuch R L, Lushene R E. Test Manual for the State-Trait Anxiety Inventory.  Palo Alto, CA: Consulting Psychologists Press; 1970
  Google Scholar
• 16 Zigmond A S, Snaith R P. The hospital anxiety and depression scale.  Acta Psychiatr Scand . 1983;  67 361-370
  CrossrefPubMedGoogle Scholar
• 17 Lewis J E, Stephens S DG, McKenna L. Tinnitus and suicide.  Clin Otolaryngol . 1994;  19 50-54
  Google Scholar
• 18 Taylor S, Koch, W J, McNally R J, Crockett D J. Conceptualizations of anxiety sensitivity.  Psychological Assessment . 1992;  4 2245-250
  PubMedGoogle Scholar
• 19 Reiss S, Peterson R A, Gurksy D M, McNally R J. Anxiety sensitivity, anxiety frequency and the prediction of fearfulness.  Behav Res Ther . 1986;  34 1-8
  PubMedGoogle Scholar
• 20 Andersson G, Strömgren T, Ström T, Lyttkens L. Randomized controlled trial of Internet-based cognitive behaviour therapy for tinnitus.  (submitted for publication). 2000; 
  PubMedGoogle Scholar
• 21 Kerns R D, Turk D C, Rudy T E. The West Haven-Yale Multidimensional Pain Inventory (WHYMPI).  Pain . 1985;  23 345-356
  CrossrefPubMedGoogle Scholar
• 22 Sullivan M, Katon W, Russo J, Dobie R, Sakai C. Coping and marital support as correlates of tinnitus disability.  General Hospital Psychiatry . 1994;  16 259-266
  CrossrefPubMedGoogle Scholar
• 23 Collins N L, Read S J. Adult attachment, working models, and relationship quality in dating couples.  Journal of Personality and Social Psychology . 1990;  58 644-646
  CrossrefPubMedGoogle Scholar
• 24 Granqvist P, Lantto S, Ortiz L, Andersson G. Adult attachment, perceived family support, and problems experienced by tinnitus sufferers.  Psychology and Health 2001, In press.
  PubMedGoogle Scholar
• 25 Wevers M E, Lowe N K. A critical review of visual analogue scales in the measurement of clinical phenomena.  Res Nurs Health . 1990;  13 227-236
  CrossrefPubMedGoogle Scholar
• 26 Axelsson A, Coles R, Erlandsson S, Meikle M, Vernon J. Evaluation of tinnitus treatment: methodological aspects.  J Audiol Med . 1993;  2 141-150
  PubMedGoogle Scholar
• 27 Andersson G, Lyttkens L, Larsen H C. Distinguishing levels of tinnitus distress.  Clin Otolaryngol . 1999;  24 404-410
  CrossrefPubMedGoogle Scholar
• 28 Hiller W, Goebel G, Schindelmann U. Developing a structured interview to assess audiological, aetiological and psychological variables of tinnitus. In: Hazell J, ed. Proceedings of the Sixth International Tinnitus Seminar Cambridge: The Tinnitus and Hyperacusis Centre 1999: 277-282
  Google Scholar
• 29 Klockhoff I, Lindblom U. Menière's disease and hydrochlorothiazide (Dichlotride℗)-a critical analysis of symptoms and therapeutic effects.  Acta Otolaryngol (Stockh) . 1967;  63 347-365
  PubMedGoogle Scholar
• 30 McKenna L, Hallam R. A neuropsychological study of concentration problems in tinnitus patients. In: Hazell J, ed. Proceedings of the Sixth International Tinnitus Seminar Cambridge: The Tinnitus and Hyperacusis Centre 1999: 108-113
  Google Scholar
• 31 McKenna L, Hallam R S, Shurlock L. Cognitive functioning in tinnitus patients. In: Reich GE, Vernon JA, eds. Proceedings of the Fifth International Tinnitus Seminar 1995 Portland, OR: American Tinnitus Association 1996: 589-595
  Google Scholar
• 32 Anastasi A. Psychological Testing, 5th ed. New York: Macmillian 1988
  Google Scholar
• 33 Blanchard E B. Behavioral medicine and health psychology. In: Bergin AE, Garfield SL, eds. Handbook of Psychotherapy and Behavior Change New York: Wiley 1994: 701-733
  Google Scholar
• 34 Jastreboff P J, Hazell J WP, Graham R L. Neurophysiological model of tinnitus: dependence of the minimal masking level on treatment outcome.  Hear Res . 1994;  80 216-232
  CrossrefPubMedGoogle Scholar
• 35 Andersson G. A cognitive-affective theory for tinnitus: the changing-state hypothesis.  2000; (manuscript in preparation).
  PubMedGoogle Scholar
• 36 Jones D M, Macken W J. Irrelevant tones produce an irrelevant speech effect.  Journal of Experimental Psychology: Learning, Memory, and Cognition . 1993;  19 369-381
  PubMedGoogle Scholar
• 37 Mirz F, Pedersen C B, Ishizu K. Positron emission tomography of cortical centres of tinnitus.  Hear Res . 1999;  134 133-144
  CrossrefPubMedGoogle Scholar
• 38 Morin C M. Insomnia. Psychological Assessment and Managment New York: Guilford Press; 1993
  Google Scholar
• 39 Mimeault V, Morin C M. Self-help treatment for insomnia: bibliotherapy with and without professional guidance.  J Consult Clin Psychol . 1999;  67 511-519
  CrossrefPubMedGoogle Scholar
• 40 Strom L, Pettersson R, Andersson G. A controlled trial of self-help treatment of recurrent headache conducted via the internet.  J Consult Clin Psychol . 2000;  68 722-727
  CrossrefPubMedGoogle Scholar
• 41 Wilson P H, Henry J L, Andersson G, Hallam R S, Lindberg P. A critical analysis of directive counselling as a component of tinnitus retraining therapy.  Br J Audiol . 1998;  32 273-286
  PubMedGoogle Scholar
• 42 Attias J, Shemsh Z, Sohmer H. Comparison between self-hypnosis, masking and attentiveness for alleviation of chronic tinnitus.  Audiology . 1993;  32 302-212
  PubMedGoogle Scholar
• 43 Ireland C E, Wilson P H, Tonkin J P, Platt-Hepworth S. An evaluation of relaxation training in the treatment of tinnitus.  Behav Res Therap . 1985;  23 423-430
  PubMedGoogle Scholar
• 44 Roth A, Fonagy P. What Work's for Whom?. A Critical Review of Psychotherapy Research New York: Guilford Press; 1996
  Google Scholar
• 45 Schneer H I. Psychodynamics of tinnitus.  Psychoanal Q . 1956;  25 72-78
  PubMedGoogle Scholar
• 46 Coles R RA. A survey of tinnitus management in national health service hospitals.  Clin Otolaryngol . 1992;  17 313-316
  PubMedGoogle Scholar
• 47 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Press 1994
  Google Scholar
• 48 Henry J, Wilson P. Psychological management of tinnitus. In:Tyler RS, ed. Tinnitus Handbook San Diego, CA: Singular-Thomson Learning 2000: 263-279
  Google Scholar
• 49 Andersson G, Vretblad P, Larsen H-C, Lyttkens L. Longitudinal follow-up of tinnitus complaints.  Arch Otolaryngol Head Neck Surg 2001; (In press).
  PubMedGoogle Scholar
• 50 Jakes S C, Hallam R S, McKenna L, Hinchcliffe R. Group therapy for medical patients: an application to tinnitus.  Cognitive Therapy and Research . 1992;  16 67-82
  CrossrefPubMedGoogle Scholar
• 51 Haerkötter C, Hiller W. Combining elements of tinnitus retraining therapy (TRT) and cognitive-behavioral therapy: does it work?. In: Hazell J, ed. Proceedings of the Sixth International Tinnitus Seminar Cambridge: The Tinnitus and Hyperacusis Centre 1999: 399-402
  Google Scholar
• 52 Henry J, Wilson P. Cognitive-behavioral therapy for tinnitus-related distress: an experimental evaluation of initial treatment and relapse prevention. In: Hazell J, ed. Proceedings of the Sixth International Tinnitus Seminar Cambridge: The Tinnitus and Hyperacusis Centre 1999: 399-402
  Google Scholar