Mindfulness-Based Tinnitus Stress Reduction

Science & Healing

With the development of the Mindfulness Based Stress Reduction (MBSR) 8-week program pioneered by Jon Kabat-Zinn of the University of Massachusetts Medical Center in 1979, the field of mindfulness research has blossomed into a compelling body of research.

Mindfulness meditation-based treatment approaches have been successfully used in the treatment of a range of chronic conditions such as fibromyalgia (Grossman et al. 2007), chronic fatigue (Surawy et al. 2005), multiple sclerosis (Grossman et al. 2010), psoriasis (Kabat-Zinn et al. 2003), cancer (Speca et al. 2006), depression and anxiety (Brown and Ryan 2003; Carlson et al. 2004; Hofmann et al. 2010; Kabat-Zinn et al. 1992; Mason and Hargreaves 2001), depressive relapse (Ma and Teasdale 2004; Teasdale et al. 2000), PTSD (Smith et al. 2011), stress (Shapiro et al. 1998), and chronic pain (Grossman et al. 2007; Kabat-Zinn et al. 1992; Kaplan et al. 1993; Morone et al. 2008; Randolph et al. 1999).

Research showing such efficacy has led to the recent investigation of mindfulness-based treatments in the management of tinnitus.

Here are some of our most recent findings about the effectiveness of mindfulness practice and its application to tinnitus healing:

Mindfulness practice leads to increases in region brain gray matter density.

Britta K. Hözel, James Carmody, Mark Vangel, Christina Congleton, Sita M. Yerramsetti, Tim Gard, Sara W. Lazar

Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. britta@nmr.mgh.harvard.edu

Therapeutic interventions that incorporate training in mindfulness meditation have become increasingly popular, but to date little is known about neural mechanisms associated with these interventions. Mindfulness-Based Stress Reduction (MBSR), one of the most widely used mindfulness training programs, has been reported to produce positive effects on psychological well-being and to ameliorate symptoms of a number of disorders. Here, we report a controlled longitudinal study to investigate pre-post changes in brain gray matter concentration attributable to participation in an MBSR program. Anatomical magnetic resonance (MR) images from 16 healthy, meditation-naïve participants were obtained before and after they underwent the 8-week program. Changes in gray matter concentration were investigated using voxel-based morphometry, and compared with a waiting list control group of 17 individuals. Analyses in a priori regions of interest confirmed increases in gray matter concentration within the left hippocampus. Whole brain analyses identified increases in the posterior cingulate cortex, the temporo-parietal junction, and the cerebellum in the MBSR group compared with the controls. The results suggest that participation in MBSR is associated with changes in gray matter concentration in brain regions involved in learning and memory processes, emotion regulation, self-referential processing, and perspective taking.

"Mindfulness practice leads to increases in regional brain gray matter density." Psychiatry Research: Neuroimaging 191 (2011): 36-43.

Mindfulness Based Tinnitus Stress Reduction Pilot Study.

Gans J, O'Sullivan P, Bircheff V

Mindfulness, Volume 3, No 4, December 2012

This pilot study aims to investigate whether a novel mind–body intervention, Mindfulness Based Tinnitus Stress Reduction (MBTSR), may be a beneficial treatment for chronic tinnitus. Eight tinnitus patients who had previously received Tinnitus Counseling (standard of care) at the University of California, San Francisco (UCSF) Audiology Clinic participated in the MBTSR program. The program included 8 weeks of group instruction on mindfulness practice, a 1-day retreat, supplementary readings, and home-based practice using meditation CDs. Using a pre–post intervention design, mean differences (paired t-tests) were calculated. Benefits were measured by a reduction in clinical symptoms, if present, and a tinnitus symptom perception shift. Tinnitus symptom activity and discomfort as well as psychological outcomes were assessed by self-report questionnaires. Both quantitative and qualitative data were gathered. Results indicate that Effect Sizes, if supported by a larger study, may be clinically significant and demonstrate a substantial decrease for items measuring perceived annoyance and perception of handicap of tinnitus. Change scores on study measures all moved in the hypothesized direction, with the exception of negligible change found for the Acting with Awareness (d=−0.05) factor of mindfulness. This pilot study provides preliminary evidence that an 8-week MBTSR program may be an effective intervention for treating chronic tinnitus and its comorbid symptoms, and may help reduce depression and phobic anxiety while improving social functioning and overall mental health. These promising findings warrant further investigation with a randomized controlled trial.

Mindfulness Based Tinnitus Stress Reduction Pilot Study, Mindfulness, Volume 3, No 4, December 2012.

Effective and viable mind-body stress reduction in the workplace: a randomized controlled trial.

Wolever RQ, Bobinet KJ, McCabe K, Mackenzie ER, Fekete E, Kusnick CA, Baime M.

Duke Integrative Medicine and Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27710, USA. ruth.wolever@duke.edu

Highly stressed employees are subject to greater health risks, increased cost, and productivity losses than those with normal stress levels. To address this issue in an evidence-based manner, worksite stress management programs must be able to engage individuals as well as capture data on stress, health indices, work productivity, and health care costs. In this randomized controlled pilot, our primary objective was to evaluate the viability and proof of concept for two mind-body workplace stress reduction programs (one therapeutic yoga-based and the other mindfulness-based), in order to set the stage for larger cost-effectiveness trials. A second objective was to evaluate 2 delivery venues of the mindfulness-based intervention (online vs. in-person). Intention-to-treat principles and 2 (pre and post) × 3 (group) repeated-measures analysis of covariance procedures examined group differences over time on perceived stress and secondary measures to clarify which variables to include in future studies: sleep quality, mood, pain levels, work productivity, mindfulness, blood pressure, breathing rate, and heart rate variability (a measure of autonomic balance). Two hundred and thirty-nine employee volunteers were randomized into a therapeutic yoga worksite stress reduction program, 1 of 2 mindfulness-based programs, or a control group that participated only in assessment. Compared with the control group, the mind-body interventions showed significantly greater improvements on perceived stress, sleep quality, and the heart rhythm coherence ratio of heart rate variability. The two delivery venues for the mindfulness program produced basically equivalent results. Both the mindfulness-based and therapeutic yoga programs may provide viable and effective interventions to target high stress levels, sleep quality, and autonomic balance in employees.

PsycINFO Database Record (c) 2012 APA, all rights reserved. J Occup Health Psychol. 2012 Apr;17(2):246-58. doi: 10.1037/a0027278. Epub 2012 Feb 20.

Mindfulness-based stress reduction for people with chronic diseases.

Merkes M.

Australian Institute for Primary Care, La Trobe University, Bundoora, Vic. 3086, Australia. m.merkes@latrobe.edu.au

Mindfulness-based stress reduction (MBSR) is a structured group program that uses mindfulness meditation to improve well-being and alleviate suffering. This article reviews the impact of MBSR for people with chronic diseases. The review includes original research that was published in English and peer-reviewed and reported outcomes for adults with chronic diseases who had participated in an MBSR program. Fifteen studies were identified. Outcomes related to mental and physical health, well-being, and quality of life. The studies included different research designs, and used self-report and physiological outcome measures. Participants' clinical diagnoses included fibromyalgia, chronic pain, rheumatoid arthritis, type 2 diabetes, chronic fatigue syndrome, multiple chemical sensitivity, and cardiovascular diagnoses. All 15 studies found that participation in an MBSR program resulted in improvements. No negative change was reported between baseline and follow up. Outcomes in regard to specific variables were difficult to compare and equivocal. Overall, positive change predominated. Chronic diseases are associated with a range of unwelcome psychological and physical consequences. Participation in an MBSR program is likely to result in coping better with symptoms, improved overall well-being and quality of life, and enhanced health outcomes. As an adjunct to standard care, MBSR has potential for much wider application in Australian primary care settings.

Aust J Prim Health. 2010;16(3):200-10. doi: 10.1071/PY09063.

Alterations in brain and immune function produced by mindfulness meditation.

Davidson RJ, Kabat-Zinn J, Schumacher J, Rosenkranz M, Muller D, Santorelli SF, Urbanowski F, Harrington A, Bonus K, Sheridan JF.

Laboratory for Affective Neuroscience, Department of Psychology, University of Wisconsin, Madison, Wisconsin 53706, USA. rjdavids@facstaff.wisc.edu

OBJECTIVE: The underlying changes in biological processes that are associated with reported changes in mental and physical health in response to meditation have not been systematically explored. We performed a randomized, controlled study on the effects on brain and immune function of a well-known and widely used 8-week clinical training program in mindfulness meditation applied in a work environment with healthy employees.

METHODS: We measured brain electrical activity before and immediately after, and then 4 months after an 8-week training program in mindfulness meditation. Twenty-five subjects were tested in the meditation group. A wait-list control group (N = 16) was tested at the same points in time as the meditators. At the end of the 8-week period, subjects in both groups were vaccinated with influenza vaccine.

RESULTS: We report for the first time significant increases in left-sided anterior activation, a pattern previously associated with positive affect, in the meditators compared with the nonmeditators. We also found significant increases in antibody titers to influenza vaccine among subjects in the meditation compared with those in the wait-list control group. Finally, the magnitude of increase in left-sided activation predicted the magnitude of antibody titer rise to the vaccine.

CONCLUSIONS: These findings demonstrate that a short program in mindfulness meditation produces demonstrable effects on brain and immune function. These findings suggest that meditation may change brain and immune function in positive ways and underscore the need for additional research.

Psychosom Med. 2003 Jul-Aug;65(4):564-70.

A randomized controlled trial of mindfulness-based cognitive therapy for treating tinnitus.

Philippot P, Nef F, Clauw L, de Romrée M, Segal Z.

University of Louvain, Louvain, Belgium.

We conducted a randomized clinical trial to examine the relative effectiveness of two psychological interventions for treating tinnitus. People with tinnitus were initially offered a single session of psychoeducation about tinnitus, followed 2 months later by six weekly sessions of either mindfulness or relaxation training. Results indicated benefits from psychoeducation in reducing negative emotions, rumination and psychological difficulties of living with tinnitus. These effects were maintained or enhanced by mindfulness training that also emphasized acceptance, although they were eroded in the relaxation condition over the follow-up. Mediating processes are discussed, and suggestions for refining clinical interventions for this population are offered.

KEY PRACTITIONER MESSAGE: The present results suggest that mindfulness training might constitute a useful addition to psychoeducation for interventions targeting the psychological consequences of tinnitus.

Copyright © 2011 John Wiley & Sons, Ltd.

Clin Psychol Psychother. 2012 Sep;19(5):411-9. doi: 10.1002/cpp.756. Epub 2011 May 12.

Tinnitus rehabilitation: a mindfulness meditation cognitive behavioural therapy approach.

Sadlier M, Stephens SD, Kennedy V.

Physiotherapy Department, University Hospital of Wales, Cardiff, UK. sadliermj@cardiff.ac.uk

BACKGROUND: Chronic tinnitus is a frequent symptom presentation in clinical practice. No drug treatment to date has shown itself to be effective. The aim of the present study was to investigate the effects of cognitive behavioural therapy and meditation in tinnitus sufferers.

METHODOLOGY: Patients were selected from a dedicated tinnitus clinic in the Welsh Hearing Institute. A waiting list control design was used. Twenty-five chronic tinnitus sufferers were consecutively allocated to two groups, one receiving a cognitive behavioural therapy/meditation intervention of four one hour sessions with the other group waiting three months and subsequently treated in the same way, thereby acting as their own control. The main outcome was measured using the Hallam tinnitus questionnaire. A four to six month follow up was conducted.

RESULTS: These showed significant statistical reductions in tinnitus variables both in the active and also in the control group. Post-therapy, no significant change was found after the waiting list period. The improvement was maintained at the four to six month period.

CONCLUSION: The positive findings give support for the use of cognitive behavioural therapy/meditation for chronic tinnitus sufferers.

J Laryngol Otol. 2008 Jan;122(1):31-7. Epub 2007 Apr 23.