LETTER TO THE EDITOR Sustained Benefit of Mindfulness-Based Tinnitus Stress Reduction (MBTSR) in Adults with Chronic Tinnitus: a Pilot Study

Roughly 50 million people in the USA experience tinnitus at some point in their lives, with two to three million so severely affected that their ability to function is greatly impaired (Shargorodsky et al. 2010). Defined as auditory perceptions not produced by external sound (Baguley 2002), tinnitus and its treatment have become the focus of much recent interest. This is partly because it is the most common service-related disability for veterans returning frommilitary service (Department of Veterans Affairs 2010). As tinnitus is a multimodal disorder with many potential causes, it is a challenge to treat, and current interventions often result in limited levels of success (Meikle et al. 2007). Bothersome tinnitus is most commonly associated with symptoms of anxiety, sleep disturbance, and depression (Andersson et al. 2005; Lockwood et al. 2002). Poor attention and concentration, interference with work, and negative impact on personal relationships are also commonly reported (Heller 2003; Sanchez and Stephens 1997). Almost all patients indicate that stress makes their tinnitus worse (Hebert and Lupien 2007; Mazurek et al. 2010). Cognitive behavioral therapy (CBT) has been shown to be a helpful treatment for some (Martinez Devesa et al. 2010). CBT focuses on addressing maladaptive appraisal, avoidance, selective attention, and other psychological mechanisms that may be influencing tinnitus-related distress (Folmer and Griest 2000). Another approach is through the applied use of mindfulness. Unlike CBT, mindfulness is not a structured psychotherapy but a discipline involving a willful, nonjudgmental shifting of one’s perceptual awareness. Thoughts, emotions, and body sensations including tinnitus symptoms are seen as mental events not to be analyzed or manipulated but rather simply noticed as the mind is repeatedly brought back to the present. As such, mindfulness practice may help those with tinnitus to reappraise their sensations as impermanent rather than unbearable or unending, thus alleviating some of the co-occurring distress. One of the most common approaches to mindfulness training currently employed in Western medicine is MindfulnessBased Stress Reduction (MBSR), an 8-week group course that teaches exercising control of one’s attention in the context of adverse circumstances (Kabat-Zinn 1982). MindfulnessBased Tinnitus Stress Reduction (MBTSR) is designed after the MBSR program, but the curriculum is specifically tailored to the management of bothersome tinnitus. Content is directed towards those with chronic tinnitus, and emphasis is placed on exploring the sensation of hearing and sounds. A recent pilot study showed that MBTSR can serve as an effective intervention for tinnitus (Gans, O’Sullivan, and Bircheff 2013). Results from the pilot study indicated a clinically significant effect size (ES) in decreasing the perceived annoyance and perception of tinnitus. Preand posttreatment questionnaires provided both quantitative and qualitative indications that MBTSR helped participants decrease tinnitus annoyance and its impact on their daily lives, improve social functioning, increase non-judgmental mindfulness, and decrease their levels of depression and anxiety. Eight participants completed the original MBTSR program (defined as attendance of six or more of the eight MBTSR classes). The average age of participants was 58 (38–70, SD=±19). Six (75 %) of the participants were male and two * Dr. Jennifer J. Gans [email protected]