Mindfulness Based Tinnitus Stress Reduction Pilot Study

1 ORIGINAL PAPERM indfulness Based Tinnitus Stress Reduction Pilot StudyA Symptom Perception-Shift ProgramJennifer J. Gans&Patricia O Sullivan&Vallena BircheffPublished online: 22 January 2013#Springer Science+Business Media New York 2013 AbstractThis Pilot Study aims to investigate whether anovel mind body intervention, Mindfulness BasedTinnitus Stress Reduction (MBTSR), may be a beneficialtreatment for chronic Tinnitus . Eight Tinnitus patients whohad previously received Tinnitus Counseling (standard ofcare) at the University of California, San Francisco (UCSF)Audiology Clinic participated in the MBTSR program. Theprogram included 8 weeks of group instruction on mindful-ness practice, a 1-day retreat, supplementary readings, andhome- Based practice using meditation CDs. Using a pre post intervention design, mean differences (pairedt-tests)were calculated. Benefits were measured by a Reduction inclinical symptoms, if present, and a Tinnitus symptom per-ception shift.

2 Tinnitus symptom activity and discomfort aswell as psychological outcomes were assessed by self-reportquestionnaires. Both quantitative and qualitative data weregathered. Results indicate that Effect Sizes, if supported by alarger Study , may be clinically significant and demonstrate asubstantial decrease for items measuring perceived annoy-ance and perception of handicap of Tinnitus . Change scoreson Study measures all moved in the hypothesized direction,with the exception of negligible change found for the Actingwith Awareness (d= ) factor of Mindfulness . This pilotstudy provides preliminary evidence that an 8-weekMBTSR program may be an effective intervention for treat-ing chronic Tinnitus and its comorbid symptoms, and mayhelp reduce depression and phobic anxiety while improvingsocial functioning and overall mental health. These promis-ing findings warrant further investigation with a randomizedcontrolled Based Tinnitus Based Stress reductionIntroductionInterest in Tinnitus and its treatment has grown in recent years,largely due to increasing awareness that Tinnitus is the mostcommon service-connected disability for veterans returning fromrecent military service in Iraq and Afghanistan (Department ofVeterans Affairs2010).

3 Tinnitus is a medical term for auditoryperceptions heard in the ear(s) or head, but not produced byexternal sound (Baguley2002). This sound, which is oftendescribed as a ringing, buzzing, pulsing, whistling, or hummingnoise, can be experienced in one or both ears with varyingloudness and pitch. Approximately 50 million people in theUnited States ( % of the US population) experience tinnitusat some point in their lives (Shargorodsky et ). Around16 million of these Americans experience Tinnitus bothersomeenough to consult their doctor (Shargorodsky et ).Furthermore, 2 to 3 million are so severely affected by theirtinnitus that their ability to function is severely impaired(Shargorodsky et ). Tinnitus is a symptom rather than a disease, and may devel-op from exposure to loud noise; a head injury; aging, outer,inner, or middle ear problems; neck or jaw disorders; cardio-vascular disease; or use of prescription or non-prescriptiondrugs (Holmes and Padgham2009 ; Tyler & Baker1983 ).

4 While many theories have been proposed to explain the occur-rence of Tinnitus , it is a multimodal disorder that may havedifferent causes and different pathophysiologies. This makestinnitus difficult to treat, and oftentimes, interventions meetwith only variable success (Meikle et ).In an extensive review of the literature from 1980 to2009, Holmes and Padgham (2009) reported on the impactJ. J. Gans (*):P. O Sullivan:V. BircheffDepartment of Otolaryngology,University of University of California, 2330 Post Street,Suite 270, San Francisco, CA 94119, USAe-mail: (2014) 5:322 333 DOI can have on a person s life. For those who experiencetinnitus bothersome enough to consult their doctor, Tinnitus ismost commonly associated with symptoms of anxiety, dis-tress, sleep disturbance, and depression (Andersson et ; Lockwood et ). Disrupted sleep is the mostsignificant complaint (Megwalu et ), affecting asmany as 70 % of Tinnitus patients (Andersson et ).

5 Studies report a lifetime prevalence of 62 % for major depres-sion, with 48 % of people with Tinnitus displaying currentdepression (Harrop-Griffiths et ), and 45 % reportingan anxiety disorder (Zoger et ). Poor attention andconcentration, interference with work, and negative impact onpersonal relationships are commonly reported by patients(Heller2003; Sanchez and Stephens1997). Almost allpatients indicate that Stress or tension makes their tinnitusworse (Hebert and Lupien2007; Mazurek et ).People with intractable cases of Tinnitus are encouraged toreduce Tinnitus distress by means of counseling and education(Sweetow1986). Cognitive Behavioral Therapy (CBT) hasbeen shown to be a helpful treatment for some (MartinezDevesa et ). CBT places its focus on reducing distressby addressing a person s maladaptive appraisal, avoidance, se-lective attention, and other psychological mechanisms that maybe influencing distress regardingtinnitus.

6 Paying less attentionto or ignoring the Tinnitus in an effort to gain more control overone's Tinnitus is an emphasized goal (Folmer2002). Mindfulness meditation stems from Buddhist philosophyand psychology and constitutes a general non-judgmental ap-proach to life (Goleman1988). The Study of Mindfulness hasgrown in interest over the past 30 years in the fields of medicineand psychotherapy (Ludwig and Kabat-Zinn2008). Multiplestudies have shown Mindfulness to be helpful in the manage-ment of distressing symptoms as well as a broad range ofchronic illnesses including a decrease in mood disturbance(Brown and Ryan2003; Carlson et ; Chiesa andSerretti2009; Kabat-Zinn et ; Weiss et ), adecrease in depressive relapse (Ma & Teasdale2004; Teasdaleet ), an increase in sense of well-being (Beddoe andMurphy2004; Rosenzweig et ; Shapiro et ;Weiss et ) and a decrease in sleep disturbance (Caldwellet ; Carlson and Garland2005).

7 Mindfulnessmeditation- Based treatment approaches have been successfullyused in the treatment of a range of chronic conditions such asfibromyalgia (Grossman et ), chronic fatigue (Surawyet ), multiple sclerosis (Grossman et ), psoriasis(Kabat-Zinn et ), cancer (Speca et ), depressionand anxiety (Brown and Ryan2003; Carlson et ;Hofmann et ; Kabat-Zinn et ; Mason andHargreaves2001), depressive relapse (Ma & Teasdale2004;Teasdale et ), PTSD (Smith et ), Stress (Shapiroet ), and chronic pain (Grossman et ; Kabat-Zinn et ; ; ;Randolph et ).Most probably due to the attention given to a person sthoughts and cognitions, Mindfulness is often erroneouslycategorized as a form of CBT. While both involve an aware-ness of thoughts and their content, there are distinct differ-ences between these two practices. CBT is often specificallyaimed at treating symptoms such as anxiety or depression,and is a directive and structured type of psychotherapy withthe goal of recognizing and correcting maladaptive ways ofthinking (Beck et ).

8 Mindfulness , on the other hand,is not a structured psychotherapy, but rather a discipline tobe cultivated throughout a person's life. It involves a willfulshifting of one s attention or a systematic building of aware-ness to bring one's attention to where the mind is at anygiven time. Thoughts, body sensations, and emotions areseen as mental events not to be analyzed or manipulated butrather to simply be noticed as fleeting events in the mind'sfield of awareness. These mental events then recede fromawareness, and the mind is brought back to the presentmoment. Other mind body interventions such as relaxationtechniques have the goal of bringing about a state of relax-ation. Mindfulness practice, in contrast to CBT and relaxa-tion training, posits a non-striving stance towards aparticular outcome: it simply allows whatever is in one'sfield of awareness to be witnessed without Based Stress ReductionMindfulness Based Stress Reduction (MBSR) is a programdesigned by Jon Kabat-Zinn in the late 1970s at theUniversity of Massachusetts Medical Center; Kabat-Zinn2005).

9 MBSR is an 8-week course teaching the principlesrequired for exercising control of one s attention throughmindfulness training, while developing skills and autonomyin Mindfulness practice to be integrated into daily life(Kabat-Zinn1982). Mindfulness means paying attentionin a particular way: On purpose, in the present moment,and nonjudgmentally (Kabat-Zinn1994, ). Practicingmindfulness is not as easy as it may seem, especially forpeople with Tinnitus whose symptoms are often accompa-nied by unfounded fears that their condition may worsen,that their Tinnitus may be a sign of a brain tumor, or mayindicate impending or progressive hearing loss (Davis andMorgan2008). A struggle may develop between the personand the Tinnitus , which can lead to symptoms of fatigue,depression, anxiety, difficulty sleeping, and interpersonalproblems, all of which can impede functioning in day-to-day life.

10 Treatment using Mindfulness - Based therapiesteaches a person to change his or her relationship to thetinnitus in an effort to lessen or eliminate this management treatments are of particular interest tothose studying Tinnitus in light of the many similarities be-tween individuals suffering from Tinnitus and those sufferingMindfulness (2014) 5:322 333323from chronic pain conditions (M ller2000). With both con-ditions, there is often no single cause of the symptom, and nosingle medical or surgical treatment is effective; likewise,there is a wide range of psychological effects, and lifestyleand general health are particularly affected. Perceived lack ofcontrol over the symptom, problems with aspects of attentionand focus, maladaptive coping strategies, catastrophic think-ing, as well as the use of similar methods of treatment ( ,cognitive coping strategies, CBT, and relaxation techniques)are common features of both chronic pain and Tinnitus (M ller2000; Tonndorf1987).