Mindfulness is key to tinnitus relief
July 2, 2018
Science Daily/University of Bath
New studies suggest mindfulness-based CBT could significantly help tinnitus sufferers.
Published in the journals Ear and Hearing and Psychotherapy and Psychosomatics, the research led by Dr Laurence McKenna from University College London Hospitals NHS Foundation Trust (UCLH) and Dr Liz Marks, from Department of Psychology at the University of Bath, found that Mindfulness based Cognitive Therapy (MBCT) helps to significantly reduce the severity of tinnitus compared to relaxation-based treatments, an approach recommended by many tinnitus clinics.
Tinnitus, described as a sensation or awareness of sound that is not caused by an external sound source, affects approximately six million people in the UK -- 10 percent of the UK's population. Approximately 1 in 100 people are very distressed or disabled by it and as many as 1 in 20 people are at least moderately distressed by it. Tinnitus is associated with complaints of emotional stress, insomnia, auditory perceptual problems and concentration problems.
As yet there is no treatment to stop the tinnitus noise but this research, funded by the British Tinnitus Association (BTA), shows clearly that treatment can make it less severe, intrusive and bothersome.
Dr Liz Marks, from the Department of Psychology at the University of Bath, will explore the report's findings in more detail at the BTA's annual conference in Birmingham in September. She said: "We compared MBCT to relaxation therapy, a traditional treatment for people with chronic tinnitus, to determine if MBCT was a better option than the current recommended practice.
"In total 75 patients took part in the trial at UCLH's Royal National Throat, Nose and Ear Hospital receiving either MBCT or relaxation therapy. The study found that both treatments led to a reduction in tinnitus severity, psychological distress, anxiety and depression for patients.
"However, the MBCT treatment led to significantly greater reductions in tinnitus severity than the relaxation treatment, and this improvement lasted for longer. In addition, 182 patients who completed MBCT routinely in our clinic showed a similar level of improvement."
Relaxation therapy provides patients with specific skills to reduce stress arousal levels. In contrast, MBCT, taught by highly-trained clinical psychologists, teaches patients to pay purposeful, present-moment attention to experiences, rather than trying to supress those experiences. Practicing mindfulness meditation in this way can cultivate a more helpful way of responding to tinnitus. People learn how to 'allow' and 'accept' tinnitus, rather than having to 'fight it' or 'push it away'. Mindfulness does not aim to change the nature or sound of the tinnitus, but the therapy can lead to tinnitus becoming less intrusive, to a point where it is no longer a problem for people.
Dr Marks added: "MBCT turns traditional tinnitus treatment on its head -- so rather than trying to avoid or mask the noise, it teaches people to stop the battle with tinnitus.
"The mindfulness approach is radically different from what most tinnitus sufferers have tried before, and it may not be right for everyone. We are confident, however, that the growing research base has demonstrated how it can offer an exciting new treatment to people who may have found that traditional treatment has not been able to help them yet. We hope the results of our research will be one of the first steps to MBCT becoming more widely adopted."
David Stockdale, chief executive of the British Tinnitus Association, said: "The results of this research are extremely encouraging particularly for people with chronic tinnitus who find that current treatments are not working for them. We really hope that more people will be able to benefit from this approach moving forward."
"Funding this kind of innovative research is a major part of what we do here at the BTA but as a charity, we rely heavily on the donations made to us. We hope more people will support us as we work tirelessly to grow the understanding and knowledge around tinnitus in order to help people with the condition to manage."
Dr McKenna and Dr Marks are now continuing their research in tinnitus looking at how Cognitive Behavioural Therapy can be used to treat tinnitus related insomnia.
https://www.sciencedaily.com/releases/2018/07/180702094054.htm
Neurofeedback shows promise in treating tinnitus
November 27, 2017
Science Daily/Radiological Society of North America
Researchers using functional MRI (fMRI) have found that neurofeedback training has the potential to reduce the severity of tinnitus or even eliminate it, according to a new study
Tinnitus is the perception of noise, often ringing, in the ear. The condition is very common, affecting approximately one in five people. As sufferers start to focus on it more, they become more frustrated and anxious, which in turn makes the noise seem worse. The primary auditory cortex, the part of the brain where auditory input is processed, has been implicated in tinnitus-related distress.
For the study, researchers looked at a novel potential way to treat tinnitus by having people use neurofeedback training to turn their focus away from the sounds in their ears. Neurofeedback is a way of training the brain by allowing an individual to view some type of external indicator of brain activity and attempt to exert control over it.
"The idea is that in people with tinnitus there is an over-attention drawn to the auditory cortex, making it more active than in a healthy person," said Matthew S. Sherwood, Ph.D., research engineer and adjunct faculty in the Department of Biomedical, Industrial and Human Factors Engineering at Wright State University in Fairborn, Ohio. "Our hope is that tinnitus sufferers could use neurofeedback to divert attention away from their tinnitus and possibly make it go away."
To determine the potential efficacy of this approach, the researchers had 18 healthy volunteers with normal hearing undergo five fMRI-neurofeedback training sessions. Study participants were given earplugs through which white noise could be introduced for periods of time. The earplugs also served to block out the scanner noise.
To obtain fMRI results, the researchers used single-shot echoplanar imaging, an MRI technique that is sensitive to blood oxygen levels, providing an indirect measure of brain activity.
"We started with alternating periods of sound and no sound in order to create a map of the brain and find areas that produced the highest activity during the sound phase," Dr. Sherwood said. "Then we selected the voxels that were heavily activated when sound was being played."
The participants then participated in the fMRI-neurofeedback training phase while inside the MRI scanner. They received white noise through their earplugs and were able to view the activity in their primary auditory cortex as a bar on a screen. Each fMRI-neurofeedback training run contained eight blocks separated into a 30-second "relax" period followed by a 30-second "lower" period. Participants were instructed to watch the bar during the relax period and actively attempt to lower it by decreasing primary auditory cortex activity during the lower phase.
The researchers gave the participants techniques to help them do this, such as trying to divert attention from sound to other sensations like touch and sight.
"Many focused on breathing because it gave them a feeling of control," Dr. Sherwood said. "By diverting their attention away from sound, the participants' auditory cortex activity went down, and the signal we were measuring also went down."
A control group of nine individuals were provided sham neurofeedback -- they performed the same tasks as the other group, but the feedback came not from them but from a random participant. By performing the exact same procedures with both groups using either real or sham neurofeedback, the researchers were able to distinguish the effect of real neurofeedback on control of the primary auditory cortex.
The study represents the first time fMRI-neurofeedback training has been applied to demonstrate that there is a significant relationship between control of the primary auditory cortex and attentional processes. This is important to therapeutic development, Sherwood said, as the neural mechanisms of tinnitus are unknown but likely related to attention.
The results represent a promising avenue of research that could lead to improvements in other areas of health like pain management, according to Dr. Sherwood.
"Ultimately, we'd like take what we learned from MRI and develop a neurofeedback program that doesn't require MRI to use, such as an app or home-based therapy that could apply to tinnitus and other conditions," he said.
https://www.sciencedaily.com/releases/2017/11/171127091127.htm