Current Psychiatry Reports

, Volume 13, Issue 1, pp 31–36 | Cite as

Tinnitus-related Distress: A Review of Recent Findings

  • John M. Malouff
  • Nicola S. Schutte
  • Lucinda A. Zucker


This article reviews recent articles relevant to tinnitus-related distress (TRD). Recent studies provide evidence that 1) chronic tinnitus, which occurs in a significant percentage of adults, has stress-inducing effects similar to those of other chronic health problems; 2) the effects of tinnitus on distress are worse in individuals who have certain personality characteristics, such as type D personality and anxiety sensitivity; 3) neural activity in TRD is similar to that for pain and depression; 4) tinnitus leads to less distress in individuals who accept their condition; and 5) cognitive-behavioral treatments, including relaxation training, attention-control training, and acceptance activities, tend to reduce TRD. The recent findings suggest that it would be good practice for mental health professionals to ask patients, especially older patients, about tinnitus and to offer psychological treatment for TRD in appropriate cases. Future research on TRD might explore the extent to which the problem is genetic and the possibility of preventing TRD in individuals who have recently developed persistent tinnitus.


Tinnitus Distress Coping Treatment Acceptance 



No potential conflicts of interest relevant to this article were reported.


Papers of particular interest, published recently, have been highlighted as:• Of importance

  1. 1.
    Schlee W, Mueller N, Hartmann T, et al.: Mapping cortical hubs in tinnitus. BMC Biol 2009, 7:80.CrossRefPubMedGoogle Scholar
  2. 2.
    Heller AJ: Classification and epidemiology of tinnitus. Otolaryngol Clin North Am 2003, 36:239–248.CrossRefPubMedGoogle Scholar
  3. 3.
    Schutte NS, Noble W, Malouff JM, et al.: Evaluation of a model of distress related to tinnitus. Int J Audiol 2009, 48:428–432.CrossRefPubMedGoogle Scholar
  4. 4.
    Gopinath B, McMahon CM, Rochtchina E, et al.: Risk factors and impacts of incident tinnitus in older adults. Ann Epidemiol 2010, 20:129–135.CrossRefPubMedGoogle Scholar
  5. 5.
    Khedr EM, Ahmed MA, Shawky OA, et al.: Epidemiological study of chronic tinnitus in Assiut, Egypt. Neuroepidemiology 2010, 35:45–52.CrossRefPubMedGoogle Scholar
  6. 6.
    Ratnayake SAB, Jayarajan V, Bertlett J: Could an underlying hearing loss be a significant factor in the handicap caused by tinnitus? Noise Health 2009, 11:156–160.CrossRefPubMedGoogle Scholar
  7. 7.
    Andersson G, Freijd A, Baguley DM, Idrizbegovic E: Tinnitus distress, anxiety, depression, and hearing problems among cochlear implant patients with tinnitus. J Am Acad Audiol 2009, 20:315–319.CrossRefPubMedGoogle Scholar
  8. 8.
    Hebert S, Lupien SJ: Salivary cortisol levels, subjective stress, and tinnitus intensity in tinnitus sufferers during noise exposure in the laboratory. Int J Hygiene Environ Health 2009, 212:37–44.CrossRefGoogle Scholar
  9. 9.
    Stuerz K, Lafenthaler M, Pftaffenberger N, et al.: Body image and body concept in patients with chronic tinnitus. Eur Arch Otorhinolaryngol 2009, 266:961–965.CrossRefPubMedGoogle Scholar
  10. 10.
    Kam ACS, Cheung APP, Chan PYB, et al.: Psychometric properties of the Chinese (Cantonese) Tinnitus Handicap Inventory. Clin Otolaryngol 2009, 34:309–315.CrossRefPubMedGoogle Scholar
  11. 11.
    Crocetti A, Forti S, Ambrossetti U, et al.: Questionnaires to evaluate anxiety and depressive levels in tinnitus patients. Otolaryngol Head Neck Surg 2009, 140:403–405.CrossRefPubMedGoogle Scholar
  12. 12.
    McKnight-Eily LR, Liu Y, Perry GS, et al.: Perceived insufficient rest or sleep among adults—United States. JAMA 2008, 302:2532–2539.Google Scholar
  13. 13.
    Cronlein T, Langguth B, Geisler P, et al.: Tinnitus and insomnia. Prog Brain Res 2007, 166:227–233.CrossRefPubMedGoogle Scholar
  14. 14.
    Langguth B, Kleinjung T, Fischer B, et al.: Tinnitus severity, depression, and the big five personality traits. Prog Brain Res 2007, 166:221–225.CrossRefPubMedGoogle Scholar
  15. 15.
    Stathopoulou G, Powers MB, Berry AC, et al.: Exercise interventions for mental health: a quantitative and qualitative review. Clin Psychol Science Pract 2006, 13:179–193.CrossRefGoogle Scholar
  16. 16.
    Chandra RK, Epstein VA, Fishman AJ: Prevalence of depression and antidepressant use in an otolaryngology patient population. Otolaryngol Head Neck Surg 2009, 141:136–138.CrossRefPubMedGoogle Scholar
  17. 17.
    Schaaf H, Eipp C, Deubner R, et al.: Psychosocial aspects of coping with tinnitus and psoriasis patients. A comparative study of suicidal tendencies, anxiety and depression [in German]. HNO 2009, 57:57–63.CrossRefPubMedGoogle Scholar
  18. 18.
    Vanneste S, Plazier M, van der Loo E, et al.: The neural correlates of tinnitus-related distress. Neuroimage 2010, 52:470–480.CrossRefPubMedGoogle Scholar
  19. 19.
    Mobasher A, Brinkmeyer J, Warbrick T, et al.: Laser-evoked potential P2 single-trial amplitudes covary with the fMRI BOLD response in the medial pain system and interconnected subcortical structures. Neuroimage 2009, 45:917–926.CrossRefGoogle Scholar
  20. 20.
    Von Leupoldt A, Sommer T, Kegat S, et al.: Dyspnea and pain share emotion-related brain network. Neuroimage 2009, 48:200–206.CrossRefGoogle Scholar
  21. 21.
    Bartels H, Middel B, Pedersen SS, et al.: The distressed (type D) personality is independently associated with tinnitus: a case-control study. Psychosomatics 2010, 51:29–38.CrossRefPubMedGoogle Scholar
  22. 22.
    Bartels H, Pedersen SS, van der Laan BFAM, et al.: The impact of type D personality on health-related quality of life in tinnitus patients is mainly mediated by anxiety and depression. Otol Neurotol 2010, 31:11–18.CrossRefPubMedGoogle Scholar
  23. 23.
    Mols F, Denollet J: Type D personality among noncardiovascular patient populations: a systematic review. Gen Hosp Psychiatry 2010, 32:66–72.CrossRefPubMedGoogle Scholar
  24. 24.
    Hesser H, Andersson G: The role of anxiety sensitivity and behavioural avoidance in tinnitus disability. Int J Audiol 2009, 48:295–299.CrossRefPubMedGoogle Scholar
  25. 25.
    • Hesser H, Westin V, Hayes SC, Andersson G: Clients in-session acceptance and cognitive defusion behaviors in acceptance-based treatment of tinnitus distress. Behav Res Ther 2009, 47:523–528. Nineteen TRD clients receiving acceptance and commitment therapy showed a significant improvement from preintervention to 6-month follow-up, with a within-group Cohen’s d of 0.91. The findings, based on a sample within a larger study, suggest that acceptance and commitment therapy may hold promise as a treatment of TRD. CrossRefPubMedGoogle Scholar
  26. 26.
    Blackledge JT, Ciarrochi J, Deane FP: Acceptance and Commitment Therapy. Queensland, Australia: Australian Academic Press; 2009.Google Scholar
  27. 27.
    Brown KW, Ryan RM: The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol 2003, 84:822–848.CrossRefPubMedGoogle Scholar
  28. 28.
    Tyler RS: Tinnitus Treatment: Clinical Protocols. New York: Thieme; 2006.Google Scholar
  29. 29.
    Latifpour DH, Grenner J, Sjodahl C: The effect of a new treatment based on somatosensory stimulation in a group of patients with somatically related tinnitus. Int Tinnitus J 2009, 15:94–99.PubMedGoogle Scholar
  30. 30.
    • Vanneste S, Plazier M, Ost J, et al.: Bilateral dorsolateral prefrontal cortex modulation for tinnitus by transcranial direct stimulation: a preliminary clinical study. Exp Brain Res 2010, 202:779–785. This study found that 30% of patients who received bilateral dorsolateral prefrontal cortex stimulation showed immediate reductions in TRD, providing initial support for a new treatment approach. TRD reduction occurred more often in patients with left-side tinnitus than in those with right-side tinnitus. CrossRefPubMedGoogle Scholar
  31. 31.
    Avery DH, Holtzheimer PE, Fawaz W, et al.: Transcranial magnetic stimulation reduces pain in patients with major depression: a sham-controlled study. J Nerv Ment Dis 2007, 195:378–381.PubMedGoogle Scholar
  32. 32.
    Fregni F, Boggio PS, Nitsche MA, et al.: Treatment of major depression with transcranial direct current stimulation. Bipolar Disord 2006, 8:203–204.CrossRefPubMedGoogle Scholar
  33. 33.
    Oishi N, Kanzaki S, Shinden S, et al.: Effects of selective serotonin reuptake inhibitor on treating tinnitus in patients stratified for presence of depression or anxiety. Audiol Neurotol 2010, 15:187–193.CrossRefGoogle Scholar
  34. 34.
    Robinson SK, Virre ES, Bailey KA, et al.: Randomized placebo-controlled trial of a selective serotonin reuptake inhibitor in the treatment of nondepressed tinnitus subjects. Psychosom Med 2005, 67:981–988.CrossRefPubMedGoogle Scholar
  35. 35.
    De Ridder D, Vanneste S, Adriaenssens I, et al.: Microvascular decompression for tinnitus: significant improvement for tinnitus intensity without improvement for distress: a 4-year limit. Neurosurgery 2010, 66:656–660.CrossRefPubMedGoogle Scholar
  36. 36.
    Pasahow RJ: Energy psychology and thought field therapy in the treatment of tinnitus. Int Tinnitus J 2009, 15:130–133.PubMedGoogle Scholar
  37. 37.
    Gerhards F, Brehmer D: Distraction and relaxation training in acute tinnitus: effects of a complement to otorhinolaryngological treatment [in German]. HNO 2010, 58:488–496.CrossRefPubMedGoogle Scholar
  38. 38.
    Malouff JM, Noble W, Schutte NS, Bhullar N: The effectiveness of bibliotherapy in alleviating tinnitus-related distress. J Psychosom Res 2010, 68:245–251.CrossRefPubMedGoogle Scholar
  39. 39.
    Abbott JAM, Kaldo V, Klein B, et al.: A cluster randomised trial of an Internet-based intervention program for tinnitus distress in an industrial setting. Cogn Behav Ther 2009, 38:162–173.CrossRefPubMedGoogle Scholar
  40. 40.
    Kaldo V, Levin S, Widersson J, et al.: Internet versus group cognitive-behavioral treatment of distress associated with tinnitus: a randomized controlled trial. Behav Ther 2008, 39:348–359.CrossRefPubMedGoogle Scholar
  41. 41.
    Mazurek B, Seydel C, Haupt H, et al.: Integrated intensive treatment of tinnitus: decrease of the tinnitus-related distress during a one-year follow-up study [in German]. Gesundheitswesen 2009, 71:35–40.CrossRefPubMedGoogle Scholar
  42. 42.
    Holdefer L, Oliveira CA, Venosa AR: Group therapy for patients with tinnitus at the University of Brasilia Medical School. Braz J Otorhinolaryngol 2010, 76:102–106.PubMedGoogle Scholar
  43. 43.
    Reger MA, Gahm GA: A meta-analysis of the effects of Internet- and computer-based cognitive-behavioral treatments for anxiety. J Clin Psychol 2009, 65:53–75.CrossRefPubMedGoogle Scholar
  44. 44.
    Folkman S, Moskowitz JT: Coping: pitfalls and promise. Annu Rev Psychol 2004, 55:745–774.CrossRefPubMedGoogle Scholar
  45. 45.
    Tolin DF: Is cognitive-behavioral therapy more effective than other therapies? A meta-analytic review. Clin Psychol Rev 2010, 30:710–720.CrossRefPubMedGoogle Scholar
  46. 46.
    Wampold BE: How does psychotherapy work? In The Basics of Psychotherapy: An Introduction to Theory and Practice. Edited by Wampold BE. Washington, DC: American Psychological Association; 2010:85–106.Google Scholar
  47. 47.
    Malouff JM, Rooke SE, Schutte NS: The heritability of human behavior: results of aggregating meta-analyses: Curr Psychol 2008, 27:153–162.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • John M. Malouff
    • 1
  • Nicola S. Schutte
    • 1
  • Lucinda A. Zucker
    • 1
  1. 1.Department of PsychologyUniversity of New EnglandArmidaleAustralia

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