Metacognitive Therapy in Patients with Tinnitus: a Single Group Study

  • Laura FerraroEmail author
  • Daniele La Barbera
  • Aldo Messina
  • Simona Galioto
  • Anna Maria Marinaro
  • Chiara Caruso
  • Rosalinda Rizzo
  • Caterina La Cascia
Original Paper


Tinnitus is often in comorbidity with anxiety and depression, and several authors have proposed a reduced efficiency of the top-down executive control in its perception. This single-group study describes a novel application of the metacognitive therapy (MCT), which works on a top-down engagement of proactive attentional control mechanisms on a group of patients with tinnitus, to see its impact on the perception of tinnitus and its anxiety and depression correlates. Eight metacognitive therapy group-sessions were proposed to a group of nine patients, as part of a regional project conducted at the University General Hospital “Paolo Giaccone” of Palermo. The last was a follow-up session, proposed three months after the seventh. The Tinnitus Handicap Inventory (THI) and the Hospital Anxiety and Depression Scale (HADS) were administered during the first, the seventh and the follow-up group session. The distress perceived by tinnitus (THI), lowered at a tolerable level at re-test, by maintaining this result up to 3 months after the conclusion of the experience (F(2) = 13.1, p = 0.001; effect size = 0.731). Distress scores (HADS) (F(2) = 8.3, p = 0.016; effect size = 0.462) and anxiety sub-scores (F(2) = 12.06, p = 0.001; effect size = 0.670) improved at the end of the experience, and the benefits stayed stable over the course of the follow-up, while depression scores did not change (p = 0.549). The use of MCT appears to offer promise in reducing the perception of the tinnitus and the anxiety of participants and reduces the significance of annoying thinking. Further studies are necessary to test its efficacy and replicability in a controlled trial.


Distress Anxiety Depression Tinnitus Metacognitive therapy 



We acknowledge all patients who took part in the project and Policlinico Hospital and Assessorato Regionale della Salute (Regione Sicilia) for its support.


This study was funded by Assessorato Regionale Della Salute Regione Sicilia, Progetto Obiettivo di Piano Sanitario Nazionale (Intesa Stato-Regione del 20/04/2011).

Compliance with Ethical Standards

Conflict of interest

Laura Ferraro, Daniele La Barbera, Aldo Messina, Simona Galioto, Anna Maria Marinaro, Chiara Caruso, Rosalinda Rizzo, and Caterina La Cascia declares that they have no conflict of interest.

Ethical Approval

All procedures performed in this study, involving human participants, were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

Informed Consent

People who asked to be included in the group, signed an informed consent form before to be engaged in the therapeutic experience and they were informed that they could leave the experience at any time.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Section of Psychiatry, Department of Experimental Biomedicine and Clinical Neurosciences (BIONEC)University of PalermoPalermoItaly
  2. 2.Audiology Unit, University General Hospital “Paolo Giaccone” of PalermoPalermoItaly

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