Biofeedback-gestützte kognitive Verhaltenstherapie bei craniomandibulären Dysfunktionen. Eine randomisiert-kontrollierte Therapiestudie zur Wirksamkeit unter Berücksichtigung psychophysiologischer Faktoren

Temporomandibular disorders (TMD) are characterized by pain or dysfunction in the temporomandibular muscles and joint. TMD are quite common affecting 5 to 10% of the adult population. Biopsychosocial models of TMD consider structural (occlusion), psychological (somatization, depression), and neurophysiological (muscular hyperactivity) factors. However, the etiology of TMD is far from being completely understood. Despite evidence for the effectiveness of cognitive-behavioral treatment, dental treatment approaches remain far more common in the clinical management of TMD. Few studies, however, have evaluated comparative effectiveness. The present dissertation pursued the following two aims: First, a short biofeedback-based cognitive-behavioral treatment was developed (study I). The approach was evaluated compared to dental treatment with occlusal relaxation splint in a randomized controlled trial of 58 patients (study II). The results showed a comparable effectiveness in terms of pain and disability reduction, however, cognitive-behavioral treatment was slightly superior in improving psychosocial functioning, pain coping, and showed higher treatment satisfaction. Improvements were independent of changes in nocturnal masseter muscle activity. Second, associations of nocturnal masseter muscle activity, TMD symptoms, psychopathology, and somatization were investigated in patients with TMD, subjects with pain free bruxism and healthy controls (study 3). The results showed elevated levels of psychopathology in patients with TMD. Though nocturnal masseter muscle activity was unrelated to pain intensity in TMD, it was positively related to TMD symptoms and somatization, which emphasizes the importance of psychophysiological arousal in the etiology of TMD. In conclusion, the present dissertation supports the importance and feasibility of biofeedback-based cognitive-behavioral treatment in comparison to dental treatment and contributes to improving the clinical management of TMD. Furthermore, the findings contribute to a better understanding of psychophysiological associations within TMD. The role of muscular hyperactivity in the etiology and treatment of TMD needs to be critically reflected.