Many tinnitus sufferers believe that their tinnitus has an organic basis and thus seek medical rather than psychological treatments. Tinnitus has been found to be associated with negative appraisal, dysfunctional attention shift, and heightened psychophysiological arousal, so cognitive-behavioral interventions and biofeedback are commonly suggested as treatments. This study developed and investigated the efficacy of a biofeedback-based cognitive-behavioral treatment for tinnitus. In total, 130 tinnitus patients were randomly assigned to an intervention or a wait-list control group. Treatment consisted of 12 sessions of a biofeedback-based behavioral intervention over a 3-month period. Patients in the wait-list group participated in the treatment after the intervention group had completed the treatment. Results showed clear improvements regarding tinnitus annoyance, diary ratings of loudness, and feelings of controllability. Furthermore, changes in coping cognitions as well as changes in depressive symptoms were found. Improvements were maintained over a 6-month follow-up period in which medium-to-large effect sizes were observed. The treatment developed and investigated in this study is well accepted and leads to clear and stable improvements. Through demonstration of psychophysiological interrelationships, the treatment enables patients to change their somatic illness perceptions to a more psychosomatic point of view.

Several models of tinnitus maintenance emphasize the importance of cognitive, emotional and psychophysiological processes. These factors contribute to distress in patients with decompensated tinnitus symptoms. We investigated whether tinnitus patients show increased physiological levels of arousal, more intense stress reactivity patterns and exaggerated psychological strain compared to healthy controls. Seventy tinnitus patients and 55 healthy controls underwent various stress tests. Muscular reactivity and peripheral arousal as well as strain ratings were assessed. Tinnitus patients reported significantly more strain during stress tests compared to healthy controls. Few physiological reactivity patterns differed significantly between the two groups. The physiological data thus only partly supported a hyperreactivity hypothesis. Strain reports and physiological data were only marginally correlated. Tinnitus patients show maladaptive appraisal processes during stress exposure, yet physiological reactivity is only slightly affected. Treatment programs for patients with decompensated tinnitus symptoms should account for appraisal processes and coping mechanisms in stressful situations.

BackgroundBorderline Personality Disorder (BPD) is a severe mental illness that is associated with low quality of life, low psychosocial functioning, and high societal costs. Treatments for BPD have improved in the last decades. Dialectical behavior therapy (DBT) and Schema therapy (ST) have demonstrated efficacy in reducing BPD symptoms and costs. However, research has not compared these two treatment approaches. In addition, there is a lack of ‘real world studies’ that replicate positive findings in regular mental healthcare settings. Thus, the PROgrams for Borderline Personality Disorder (PRO*BPD) study will compare the (cost-) effectiveness of DBT and ST in structured outpatient treatment programs in the routine clinical setting of an outpatient clinic.Methods/DesignWe aim to recruit 160 BPD patients, who will be randomly assigned to either DBT or ST. In both conditions, patients receive one group therapy and one individual therapy session/week for a maximum of 18 months. Both treatment programs have similar frameworks, which guarantee clinical equipoise. The primary outcome is a reduction of BPD-symptoms. Also, the costs related to BPD are assessed and an economic evaluation is performed from a societal perspective. Secondary outcomes examine other measures of BPD-typical and general psychopathology, comorbidity, quality of life, psychosocial functioning and participation. Data are collected prior to the beginning therapy and every six months until the end of therapy, as well as at six months, one year and two years of follow-up after the end of therapy. Finally, we conduct a qualitative study to understand patients’ experiences with the two methods.DiscussionThe PRO*BPD study is the first randomized trial to compare the (cost-) effectiveness of DBT and ST. By examining the clinical effectiveness of a broad spectrum of outcome parameters, conducting an economic evaluation and assessing patients’ experiences, this study will significantly advance our knowledge on psychotherapy for BPD and will provide insight into the treatment approaches that should be offered to different BPD patients from clinical, economic and stakeholder’s perspectives.Trial registrationGerman Clinical Trial Register, DRKS00011534, Date of registration: 11/01/2017, retrospectively registered.

The etiological tinnitus models propose that suffering can be caused and aggravated by heightened physiological arousal. Therefore psychophysiological treatments are applied. Stability of the measured parameters is essential for the use of biofeedback as well as to permit the attribution of changes to the administered treatment. The aim of our study was to investigate the 3-month reproducibility of psychophysiological parameters in 60 tinnitus patients. Using a repeated-measures design, the activity of these parameters was assessed twice during various stress and relaxation trials. The results showed that the measurements of frontalis, masseter and trapezius muscles were stable, while for the sternocleidomastoid, the skin conductance level (SCL) and the skin temperature retest-stability could not be evidenced. For all parameters, test-retest stability was weak for the relative scores. In conclusion, our study has important implications for applied psychophysiology research: (1) the measurement of EMG assessed in a clinical sample is stable over a 3-month interval; (2) in contrast, the measurements of SCL and skin temperature as well as all relative scores are less stable; and (3) the stability of EMG-parameters in our sample gives first hints that physiological changes can be attributed to an administered biofeedback treatment but further research is required.

Einleitung: Viele Tinnitusbetroffene suchen aufgrund ihres organischen Krankheitsverständnisses eher somatische als psychotherapeutische Behandlungen auf. Durch die Erweiterung verhaltenstherapeutischer Ansätze um Biofeedbackelemente kann der Einstieg in psychotherapeutische Verfahren möglicherweise erleichtert werden. Ziel der vorliegenden randomisierten kontrollierten Studie war es, ein psychophysiologisches Therapiemanual zu entwickeln und seine Akzeptanz bei chronischen Tinnituspatienten zu untersuchen. In der Behandlung werden zum einen kognitiv-behaviorale Techniken zum Einfluss von Stress und Kognitionen auf das Tinnituserleben eingesetzt. Zum anderen werden durch die Rückmeldung körperlicher Parameter psychophysiologische Zusammenhänge demonstriert. Da bei Tinnitusbetroffenen eine erhöhte Muskelanspannung im Kopf- und Schulterbereich angenommen wird, soll mittels Biofeedback die gezielte Entspannung dieser Muskeln trainiert werden. Patienten und Methode: Zur Evaluation des Therapieprogramms wurden 65 Tinnituspatienten randomisiert zur Interventions- oder Wartekontrollgruppe zugewiesen. Das Therapieergebnis wurde mit Skalen zur Zufriedenheit, dem Tinnitusfragebogen und einem Tinnitustagebuch erfasst. Ergebnisse: Die entwickelte Behandlung wurde sehr gut akzeptiert und hatte keine Nebenwirkungen. Zudem wurde eine deutliche Verringerung der Tinnitusbelastung nachgewiesen, was durch mittlere bis hohe Effektstärken unterstützt wird. Schlussfolgerung: Das entwickelte biofeedbackgestützte Behandlungsmanual stellt ein sehr gut akzeptiertes und wirksames Verfahren zur Verringerung der Tinnitusbelastung dar und erleichtert Patienten mit somatischem Krankheitsmodell durch seine Fokussierung auf physiologische Parameter den Übergang zu einer eher psychosomatischen Sichtweise.