Bioffeedback als Chance für die Tinnitusbehandlung-Entwicklung eines biofeedbackgestützten Therapieansatzes und Evaluation unter Berücksichtigung psychophysiologischer Annahmen

Chronic tinnitus is a common symptom with a prevalence of 4%. It can be accompanied by different problems and leads to severe suffering. Because of the large number of possible causes, a precise etiological model does not exist. The habituation model (Hallam et al., 1984) as well as the neurophysiological tinnitus model (Jastreboff & Hazell, 1993) assume negative appraisal processes, a dysfunctional attention-shift and a heightened cortical arousal level as possible causes of tinnitus development and maintenance. Based on these assumptions cognitive-behavioural treatments and biofeedback are applied as promising treatment approaches for chronic tinnitus. For the present dissertation two main questions were derived from the previous research. First a biofeedback-based behavioural treatment approach was developed. It was evaluated in a randomised-controlled trial on 130 patients with severe chronic tinnitus. The results showed clear and long-term stable improvements regarding tinnitus distress, coping abilities and control cognitions. Medium to large effect sizes underpinned the high clinical relevance of the achieved results. Then psychophysiological assumptions that form the basis of the implementation of biofeedback in tinnitus treatment were investigated. The retest-reliability of psychophysiological parameters was assessed. For electromyographic measures good stability coefficients were detected. Additionally the assumption of tinnitus patients' cortical hyperarousal was investigated. It was found that tinnitus patients reported a higher subjective strain than healthy controls. However regarding the objective physiological parameters no differences between the groups were detected. Altogether the psychophysiological treatment developed was highly effective and very well accepted by the patients. As the study did not show evidence for the assumed psychophysiological hyperarousal further reasons for the efficacy of biofeedback are discussed. The treatment developed can especially be recommended for patients with rather somatic illness perceptions. Through demonstrating psychophysiological interrelationships the treatment offers a link to biopsychosocial concepts and thus enables patients to change their biomedical illness perceptions.