Die Tinnitusbehandlung mit Biofeedback und kognitiver Verhaltenstherapie-Psychophysiologische Grundlagen und Intervention

Abstract The purpose of this dissertation was to examine psychophysiological basics and to evaluate a psychophysiological based cognitive-behavioral therapy for chronic tinnitus sufferers. Current models of tinnitus onset and maintenance emphasize the importance of cognitive, emotional and psychophysiological processes (Hallam, 1984, Jastreboff & Hazell, 1993). Nega-tive appraisal of the symptoms, negative emotional reactions and a lack of attentions shift as well as hyperarousal processes are supposed to complicate habituation. Different hypotheses regarding specific treatment and underlying psychophysiological principles were derived from the assumptions of current tinnitus models. 130 chronic tinnitus sufferers were randomized to either treatment group or to the waiting-list. 55 healthy controls were measured in order to be compared with tinnitus patients concerning stress reactivity. First, we investigated whether tinnitus patients differ from healthy controls in their physiological and subjective stress reactivity. Results confirmed greater subjective distress in tinnitus patients, but failed to show differences in peripher-physiological parameters. Strain reports and physiological data were not substantially correlated. A general hyperarousal of the tinnitus patients could not be demonstrated. Within the project, a manual based treatment program was developed. It included different treatment aspects: cognitive-behavioral interventions were combined with biofeedback-based relaxation training. As a second hypothesis, a substantial physiological treatment effect was expected. As results showed, muscle tense as indicators for peripheral arousal was significantly reduced after the treatment. Third, tinnitus annoyance and psychological distress was mark-edly reduced during the therapy, while coping abilities and self-efficacy were found to be improved. The moderate to high effect sizes stayed unchanged during follow-up period. The physiological and psychological changes did not correlate substantially, indicating that the treatment affected independent reaction systems. Fourth, several factors were examined to predict treatment outcome. Results showed that neither patient’s nor tinnitus characteristics acted as predictors for treatment effectiveness. Positive predictors were active and non-skeptical treatment expectancies. If patients suffered from depressive disorder, outcome was slightly reduced. Overall, instead of inconsistent findings regarding stress reactivity, the treatment approach consisting of biofeedback-based therapy combined with cognitive-behavioral treatment was found to be highly effective on physiological and psychological level. Apparently, separated response systems were activated by the treatment. Change mechanism of biofeedback as well as the study design and the methods were discussed.