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Posted by John Goddard
Would anyone like to comment on this abstract? John
1: Scand Audiol 2000;29(2):67-78 Related Articles, Books, LinkOut
Retraining therapy for chronic tinnitus. A critical analysis of its status.
Kroener-Herwig B, Biesinger E, Gerhards F, Goebel G, Verena Greimel K,
Hiller W
Clinical Psychology and Psychotherapy, University of Goettingen, Germany.
bkroene@uni-goettingen.de
Tinnitus retraining therapy (TRT), as conceived of mainly by PJ Jastreboff,
has recently received increasing attention in the media, as well as in
seminars and congresses on treatment methods for chronic tinnitus. It is
often claimed, though not explicitly in scientific publications, that TRT is
currently the most efficacious therapy for tinnitus, obtaining improvement
rates exceeding 80%. This assertion is highly significant in light of the
most likely increasing prevalence of chronic tinnitus and ensuing urgent
demand for effective therapies. Before examining the evidence regarding the
effectiveness of TRT, Jastreboff's theoretical idea of tinnitus as a
neurophysiological disorder is examined and evaluated. This idea is
plausible and is supported by some evidence. The interaction between
neuroacoustic and emotional processes emphasized by Jastreboff is, however,
neither new nor sufficiently elaborated with respect to the underlying
psychological factors. The TRT intervention technique and its main
components 'directive counselling' and use of 'noise generators' are found
to be theoretically well grounded.
The lack of detailed information concerning TRT implementation and the
potential consequence that differing interventions may be labelled TRT are
criticized.
Jastreboff's obvious opposition to psychologists' participation in TRT,
despite the increase in efficacy they could affect through utilization of
cognitive restructuring techniques and behaviour modification interventions,
is also criticized.
Finally, studies regarding the efficacy of TRT are reviewed and severe
methodological shortcomings (e.g. lack of controlled randomized group
studies) in TRT research are noted.
Taking the current state of evidence into account, we conclude that there is
no convincing empirical support for the assumption that TRT is superior to
other treatments, since no comparative studies have been conducted. It is
contended that there is more substantial empirical support for the efficacy
of cognitive-behavioural interventions in reducing tinnitus annoyance and
tinnitus-related suffering. The necessity for methodologically well-designed
studies to pinpoint effect sizes of TRT and compare them with other
techniques, especially cognitive-behavioural ones, is emphasized.
