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A Listening Ear a Listening Treatment the Treatment in Interventions Psychotherapeutic

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A Listening Ear a Listening Treatment the Treatment in Interventions Psychotherapeutic A LISTENING EAR. PSYCHOTHERAPEUTIC INTERVENTIONS IN THE TREATMENT OF CHRONIC SUBJECTIVE TINNITUS OF CHRONIC SUBJECTIVE INTERVENTIONS IN THE TREATMENT EAR. PSYCHOTHERAPEUTIC A LISTENING A LISTENING EAR PSYCHOTHERAPEUTIC INTERVENTIONS IN THE TREATMENT OF CHRONIC SUBJECTIVE TINNITUS @Stijn Gisquiere @ Stijn Gisquiere @ Stijn Gisquiere TINE LUYTEN Thesis submitted for the degree of Doctor of FACULTY OF MEDICINE AND HEALTH SCIENCES DEPT. OF TRANSLATIONAL NEUROSCIENCES Medical Sciences at the University of Antwerp Tine Luyt Supervisors: Prof. dr. Annick Gilles, Prof. dr. em. Paul Van de Heyning, en Prof. dr. em. Marc De Bodt, & Prof. dr. Frank Declau Antwerp, 2021 147260 Luyten R14 OMS.indd 2-3 21-12-2020 14:09 Copyright ã 2021 Tine Luyten Illustrations: Stijn Gisquière Printing: Ridderprint | www.ridderprint.nl ISBN: 978-94-6416-364-3 All rights reserved. No parts of this book may be reproduced or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author. 147260 Luyten BNW.indd 2 22-12-2020 13:54 Faculty of Medicine and Health Sciences A listening ear. Psychotherapeutic interventions in the treatment of chronic, subjective tinnitus Een luisterend oor. Psychotherapeutische interventies in de behandeling van chronische, subjectieve tinnitus Proefschrift voorgelegd tot het behalen van de graad van Doctor in de Medische Wetenschappen aan de Universiteit van Antwerpen te verdedigen door Tine Luyten Supervisors: Prof. dr. Annick Gilles, Prof. dr. em. Paul Van de Heyning, & Prof. dr. em. Marc De Bodt | Co-supervisor: Prof. dr. Frank Declau Antwerpen, 2021 147260 Luyten BNW.indd 3 22-12-2020 13:54 147260 Luyten BNW.indd 4 22-12-2020 13:54 Examining Committee SUPERVISORS Prof. dr. Annick Gilles – Supervisor Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium Faculty of Medicine and Health Sciences, Campus Drie Eiken, University of Antwerp, Antwerp, Belgium Department of Education, Health & Social Work, University College Ghent, Ghent, Belgium Prof. dr. em. Paul Van de Heyning – Supervisor Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium Faculty of Medicine and Health Sciences, Campus Drie Eiken, University of Antwerp (UA), Antwerp, Belgium Prof. dr. em. Marc De Bodt – Supervisor Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium Faculty of Medicine and Health Sciences, Campus Drie Eiken, University of Antwerp (UA), Antwerp, Belgium Prof. dr. Frank Declau - Co – Supervisor Department of Otorhinolaryngology and Head and Neck Surgery, GZA Hospitals, Antwerp, Belgium Faculty of Medicine and Health Sciences, Campus Drie Eiken, University of Antwerp (UA), Antwerp, Belgium 147260 Luyten BNW.indd 5 22-12-2020 13:54 147260 Luyten BNW.indd 6 22-12-2020 13:54 MEMBERS OF THE JURY Prof. dr. Olivier M. Vanderveken - Internal jury member Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium Faculty of Medicine and Health Sciences, Campus Drie Eiken, University of Antwerp (UA), Antwerp, Belgium Prof. dr. Manuel Morrens - Internal jury member Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Institute (CAPRI), Campus Drie Eiken, University of Antwerp (UA), Antwerp, Belgium Scientific Institute for Neuropsychiatric and Psychopharmacological Studies (SINAPS), University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium Prof. dr. David Baguley - External jury member President of the British Tinnitus Association, UK NIHR Nottingham Biomedical Research Center, University of Nottingham, UK Department of Hearing Sciences, Division of Clinical Neurosciences, School of Medicine, University of Nottingham, UK Prof. dr. Berthold Langguth - External jury member Head of the Multidisciplinary Tinnitus Clinic of the University of Regensburg, Regensburg, Germany Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany 147260 Luyten BNW.indd 7 22-12-2020 13:54 147260 Luyten BNW.indd 8 22-12-2020 13:54 ‘ Ring the bells that still can ring Forget your perfect offering There is a crack, a crack in everything That's how the light gets in.’ Leonard Cohen - Anthem 147260 Luyten BNW.indd 9 22-12-2020 13:54 147260 Luyten BNW.indd 10 22-12-2020 13:54 Summary Tinnitus, often referred to as ringing in the ears, is defined as the perception of sound without the presence of an external auditory input i.e. a phantom percept (De Ridder, Elgoyhen et al. 2011). Up to 8 - 20% of people worldwide receive the diagnosis of chronic tinnitus when this symptom is present for more than three months. About 1 - 3% of this population experience tinnitus as debilitating and seek medical help (Baguley, McFerran et al. 2013). Patients describe hearing wheezing, buzzing or hissing sounds, which can lead to extensive psychological burden and have a serious impact on the quality of life. A high comorbidity with insomnia, depression, and anxiety is observed in patients suffering from a severe form of tinnitus (Langguth, Kreuzer et al. 2013). Hence, diagnosis and treatment require a great deal of expertise to detect existing etiology and comorbidity. For the treatment of complex tinnitus cases, therefore, a multidisciplinary approach is recommended (Shi, Robb et al. 2014, Van de Heyning, Gilles et al. 2015). To date, there is no drug or psychotherapeutic treatment that can fully alleviate chronic subjective tinnitus. Patients suffering from chronic tinnitus often keep on seeking a cure or some form of relief for their persistent symptoms. Current recommended forms of therapy consist of psychotherapeutic interventions that are intended to train the patient, through sound enrichment and psychoeducation or through learning helpful thoughts, to learn to 147260 Luyten BNW.indd 11 22-12-2020 13:54 react differently to the tinnitus sound. Pharmacological treatments are mainly used to reduce the secondary effects of tinnitus symptoms, such as sleep difficulties, anxiety symptoms, depressive feelings and concentration problems. Studies have shown that Tinnitus Retraining Therapy (TRT) can significantly improve the quality of life for tinnitus patients. Furthermore, there is evidence for the effectiveness of cognitive behavioral therapy (CBT) that can effectively alleviate symptoms by changing dysfunctional cognitions. For a part of the patients with tinnitus symptoms, these forms of treatment lead to a reduction in their carrying burden. However, when tinnitus causes a major interference with daily functioning, these treatment methods are not sufficiently effective enough for all patients (Cima, Maes et al. 2012). Recent evidence shows that Eye Movement Desensitization and Reprocessing (EMDR) can be an effective therapy for symptoms such as chronic pain and phantom pain (Van Rood and De Roos 2009). Starting from tinnitus as phantom percept, it is possible that EMDR may be an alternative and effective treatment method for patients with tinnitus (Rikkert, Van Rood et al. 2018, Phillips, Erskine et al. 2019). This dissertation focuses on the current psychotherapeutic landscape in the treatment of chronic subjective tinnitus aiming to investigate an alternative treatment method. Therefore, the following research objectives were formulated: 147260 Luyten BNW.indd 12 22-12-2020 13:54 o Describing EMDR as a treatment method and investigating the efficacy of EMDR in the treatment of tinnitus. o Analyzing the effect of EMDR in comparison to CBT in the treatment of chronic subjective tinnitus. o Assessing whether bimodal therapy for chronic subjective tinnitus consisting of the combination of TRT and EMDR results in a clinically significant different efficacy compared to the current recommended bimodal TRT and CBT therapy. o Exploring the influence of specific personality traits as a result of the therapeutic intervention of TRT/EMDR and TRT/CBT. PART I THE VALUE OF EMDR IN THE TREATMENT OF TINNITUS The first part of this doctoral thesis examines whether there is evidence for the effectiveness of EMDR in the treatment of chronic subjective tinnitus. The systematic review describes the evaluation of two eligible studies based on the Platinum Standards. The review shows that more than 50% of patients experience clinically significant improvement after EMDR treatment. The established improvement remains stable until at least three months after therapy. The pilot studies demonstrate that EMDR creates opportunities in decreasing tinnitus distress. This is the first systematic review to provide an overview of existing studies of EMDR in the treatment of tinnitus. 147260 Luyten BNW.indd 13 22-12-2020 13:54 PART II RANDOMIZED CONTROLLED STUDY OF EMDR FOR TINNITUS The second part of this dissertation proposes the study protocol of a randomized controlled trial with blind evaluator, examining the effects of two bimodal tinnitus therapies, more specifically TRT + CBT and TRT + EMDR. Analyses of results from the Tinnitus Functional Index (TFI), Tinnitus Questionnaire (TQ), Visual Analogue Scale for Tinnitus Loudness (VASLoudness), Hyperacusis Questionnaire (HQ) and Hospital Anxiety and Depression Scale (HADS) show that both bimodal therapies lead to clinically significant improvements shortly after treatment. Measurements three months after therapy show an even greater reduction in tinnitus symptoms. Clinically significant improvement is found in terms of
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