Standardized tinnitus-specific individual cognitive-behavioral therapy: a controlled outcome study with 286 tinnitus patients.

BACKGROUND: Pharmacological treatment of tinnitus cannot be considered well established. Thus, reducing tinnitus severity through behavioral therapy is emerging as a key goal. METHODS: A total of 286 patients suffering from persistent and stable tinnitus for four months or longer participated in this controlled clinical multicenter study. The study investigated the efficacy and safety of a standardized treatment involving individual cognitive-behavioral therapy (CBT). Controls were 120 patients waiting to be treated. Therapy was standardized using manualized procedures within the setting of a specifically designed disease management program. The primary outcome measure was the tinnitus change score using an 8-point numeric verbal rating scale. Secondary outcome measures were tinnitus severity as determined by the tinnitus questionnaire score as well as the tinnitus loudness score and the tinnitus annoyance score using 6- and 8-point numeric verbal rating scales, respectively. Following a significant multivariate rank test, these four validated outcome measures were tested in the order given. RESULTS: The primary outcome measure, tinnitus change score, showed an efficacy of treatment with an odds ratio of 3.4 (95% confidence interval, 2.6-4.5). Of the treated patients, 84% showed a tinnitus change score improvement, but only 22% of controls did. The secondary outcome measures of tinnitus questionnaire score, loudness score, and annoyance score improved in the treatment group significantly more than in the control group. In the therapy group, the tinnitus questionnaire score was reduced by 50% from a median of 27 to 13.5; in the control group, no change in median tinnitus questionnaire score was observed. The multivariate endpoint of the primary and secondary outcome measures differed significantly (P < 0.0001) between treatment and control groups. The same was true when univariate scores were considered. CONCLUSIONS: A structured tinnitus-specific CBT using standardized tinnitus-specific interventions can be an effective individual therapy for the treatment of patients suffering from tinnitus for at least 4 months. The trial was registered at the ClinicalTrials.gov registry (ID: NCT 00719940).

Acculturation and cardiovascular reactivity of second-generation Turkish migrants in Germany.

OBJECTIVE: Previous studies have shown that migration and acculturation lead to higher blood pressures and a higher prevalence of cardiovascular diseases. Heightened cardiovascular reactivity is considered as a risk factor for cardiovascular diseases. Therefore, the purpose of the present study was to examine cardiovascular reactivity in young and healthy second-generation Turkish migrants to Germany. METHOD: Forty-one Turkish and 20 German male students worked on a mental arithmetic task for 6 min and underwent the cold pressor test for 90 s. Heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were taken in intervals of 2 min at baseline and during task periods. Stroke volume (SV), cardiac output (CO), preejection period (PEP), and total peripheral resistance (TPR) were registered continuously by impedance cardiography. The Turkish volunteers were divided into weak and advanced acculturated migrants based on self-ratings given in a questionnaire. RESULTS: Advanced acculturated Turkish students showed greater HR and CO increases and greater PEP and TPR decreases to the mental arithmetic task than Germans or weak acculturated Turkish students. No group differences were found for the cold pressor test. CONCLUSION: Migrants' acculturation is associated with an enhanced beta-adrenergic activation pattern of the sympathetic nervous system that might put them at greater risk with regards to essential hypertension and coronary heart disease.