Date of Award

2020

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department

Physician Assistant Studies

Abstract

OBJECTIVE: The objective of this selective EBM review is to determine whether or not mindfulness-based cognitive therapy (MBCT) is an effective treatment for adult patients with tinnitus.

STUDY DESIGN: Systematic review of two randomized controlled trials (RCTs) published in 2012 and 2017 and one cohort study published in 2018.

DATA SOURCES: Data sources for this review are articles published in peer-reviewed journals retrieved from PubMed and Cochrane Library.

OUTCOMES MEASURED: The outcomes evaluated are tinnitus severity and tinnitus distress as determined by the Tinnitus Questionnaire (TQ) and overall negative affect as determined by the Tinnitus Psychological Impact Questionnaire (QIPA). The TQ is a patient-completed questionnaire in which 19 of the 41 questions focus on tinnitus severity or distress (McKenna L, Marks E, Hallsworth C, Schaette R. Psychother Psychosom. 2017;86:351-361. doi: 10.1159/000478267 and McKenna L, Marks E, Vogt F. Ear Hearing. 2018;39(2):359-366. doi: 10.1097/AUD.0000000000000491). The QIPA is a patient-completed questionnaire designed by Philippot, Nef, Clauw, et al. to assess tinnitus severity over the last week based on six different dimensions (Clin Psychol Psychot. 2012;19:411-419. doi: 10.1002/cpp.756).

RESULTS: All three studies reveal that MBCT provides statistically significant improvements in tinnitus based on the outcomes measured. Both RCTs find that MBCT is more effective than relaxation training (RT) at improving tinnitus severity with a p of 0.006 at a 6-month follow-up (McKenna L, Marks E, Hallsworth C, Schaette R. Psychother Psychosom. 2017;86:351-361. doi: 10.1159/000478267) and negative affect with a p of < 0.02 at a 3-month follow-up (Philippot P, Nef F, Clauw L, de Romrée M, Segal Z. Clin Psychol Psychot. 2012;19:411-419. doi: 10.1002/cpp.756). The cohort study further supports the effectiveness of MBCT with a decrease in tinnitus distress at both post-intervention and 6-week follow-up times having a p of < 0.001 (McKenna L, Marks E, Vogt F. Ear Hearing. 2018;39(2):359-366. doi: 10.1097/AUD.0000000000000491).

CONCLUSIONS: Despite all three studies indicating that MBCT is effective at reducing some of the negative effects of chronic tinnitus in adult populations, more research is necessary to adequately determine the long-term efficacy of mindfulness-based cognitive therapy in the treatment of tinnitus.

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