Cognitive Behavioural Therapy for Tinnitus

A Cochrane review [Abstract] 1 included 28 studies (mostly from Europe) with a total of 2733 patients. All patients had had tinnitus for at least 3 months, the average age ranged from 43 to 70 years. The duration of the cognitive behavioural therapy (CBT) ranged from 3 to 22 weeks and it was mostly conducted in hospitals or online. The results refer to outcomes at end of treatment due to an absence of evidence at the other follow-up time points.

• CBT vs. no intervention/wait list control (14 studies): CBT may reduce the impact of tinnitus on quality of life at treatment end (SMD -0.56, 95% CI -0.83 to -0.30; 10 studies, n=537). Re-expressed as a score on the Tinnitus Handicap Inventory (THI; range 0 to 100) this is equivalent to a score 10.91 points lower in the CBT group, with an estimated minimal clinically important difference (MCID) for this scale being 7 points. For the secondary outcomes, CBT may result in a slight reduction in depression (SMD -0.34, 95% CI -0.60 to -0.08; 8 studies, n=502). However, it is uncertain whether CBT reduces anxiety, improves health-related quality of life or reduces negatively biased interpretations of tinnitus.
• CBT vs. audiological care (3 studies): CBT probably reduces the impact of tinnitus on quality of life as measured by the THI (range 0 to 100; MD -5.65, 95% CI -9.79 to -1.50; 3 studies, n=444) (MCID=7 points). The evidence suggests that CBT may slightly reduce depression but may result in little or no difference in anxiety or health-related quality of life. CBT may reduce negatively biased interpretations of tinnitus.
• CBT vs. tinnitus retraining therapy (TRT) (one study): TRT included bilateral sound generators as per TRT protocol. CBT may reduce the impact of tinnitus on quality of life as measured by the THI (MD -15.79, 95% CI -27.91 to -3.67; 1 study, n=42). It is uncertain whether CBT reduces depression and anxiety or improves health-related quality of life. CBT may reduce negatively biased interpretations of tinnitus.
• CBT vs. other active control (16 studies): Active controls included relaxation, information and Internet-based discussion forums. CBT may reduce the impact of tinnitus on quality of life (SMD -0.30, 95% CI -0.55 to -0.05; 12 studies, n=966). Re-expressed as a THI score this is equivalent to 5.84 points lower in the CBT group (MCID=7 points). CBT may reduce depression and anxiety. It is uncertain whether CBT improves health-related quality of life. CBT probably reduces negatively biased interpretations of tinnitus.

Comment: The quality of evidence is downgraded by indirectness (short follow-up).

References

• Fuller T, Cima R, Langguth B et al. Cognitive behavioural therapy for tinnitus. Cochrane Database Syst Rev 2020;1():CD012614. [PubMed]