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Psychophysiologic Treatment of Chronic Tinnitus: A Randomized Clinical Trial

From the Department of Clinical Psychology, University of Marburg, Germany.

Address correspondence and reprint requests to Winfried Rief, Department of Clinical Psychology and Psychotherapy, University of Marburg, Gutenbergstrasse 18, D- 35032 Marburg, Germany. E-mail: rief{at}staff.uni-marburg.de

Background: Tinnitus seems to be associated with psychophysiological over-activation (e.g., of head and shoulder muscles). Therefore we aimed to develop and evaluate a new intervention program including a psychophysiological approach.

Methods: Forty-three tinnitus sufferers were randomized to 2 groups, one receiving a psychophysiologically oriented intervention lasting 7 intervention sessions (plus 2 assessment sessions), whereas the other group waited for a comparable time period. Afterward, patients on the waiting list also received the intervention. Physiological variables were muscle activity of head and shoulders and electrodermal activity. Psychological assessments took place at pretreatment, post-treatment, and 6 months later. Follow-up data were available from 95% of participants. Major outcome variables were self-rating scales (e.g., tinnitus annoyance assessed by the Tinnitus Questionnaire), and diary data (self-control, daily time of perceiving the tinnitus).

Results: On most tinnitus specific variables, patients in the treatment group improved significantly more than patients on the waiting list. Main effect sizes for tinnitus-specific variables were up to 0.89. Muscle reactivity of head muscles at the beginning predicted significant treatment effects.

Conclusion: Compared with meta-analytical reviews of psychological interventions for tinnitus sufferers, the presented treatment is brief and in the upper range of effectiveness.

Key Words: tinnitus • physiological activity • biofeedback • self-control • cognitive-behavioral therapy • randomized clinical trial

Abbreviations: ES = effect size; GSI = General Symptomatic Index (mean score of Brief Symptom Inventory); IG = intervention group; MG = merged group; SCL-90R = symptom check list; TQ = Tinnitus Questionnaire; WLG = waiting list group.