Behm Res. Thu. Vol. 24, No. 5, pp. 497-507, 1986 0005-7967/86 $3.00 + 0.00 Printed zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA in Great Britain Pergamon Journals Ltd THE EFFECTS OF REASSURANCE, RELAXATION TRAINING AND DISTRACTION ON CHRONIC TINNITUS SUFFERERS S. C. JAKES,’ R. S. HALLAM,’ S. RACHMAN~ and R. HINCHCLIFFE’ ‘Institute of Laryngology and Otology, 330-332 Gray’s Inn Road, London WCIX 8EE, England ZDepartment of Psychology, University of British Columbia, Vancouver, B.C., Canada [Received 29 November 1985) Summary-The effects of psychological therapy on tinnitus distress were assessed in a three-factor experiment: (1) progressive muscle relaxation therapy was compared to progressive muscle relaxation therapy combined with ‘attention-switching’ training; (2) immediate therapy was compared to delayed therapy; and (3) two therapists were compared. In addition to these three between-s factors, occasions constituted a within& factor. Before treatment all Ss went through an ‘information/orientation’ phase. Basic information about tinnitus management (including the role of attitudes and beliefs) was provided together with orientation to coping as a goal of treatment. The annoyance caused by tinnitus and the loudness of the tinnitus were rated separately three times/day, and insomnia was recorded. Data about the ‘distress’ and ‘insomnia’ caused by the tinnitus, the ‘intrusiveness’ of tinnitus and the number of activities affected by the tinnitus, was collected by questionnaire. The annoyance of tinnitus decreased more rapidly at the beginning of treatment than during the orientation period, and continued to decline during therapy. Neither the loudness nor the intrusiveness of the tinnitus declined during therapy. The distress’ arising from the tinnitus, and the ‘activities affected’ by the tinnitus declined during treatment, and also during the orientation phase. The effects on insomnia were inconsistent. The results are discussed in relation to a model of tinnitus-annoyance. INTRODUCTION The phenomenon of hearing noises which have no external source (tinnitus) is almost universal under quiet conditions (Heller and Bergman, 1953). Epidemiological studies have shown that reporting this experience is commonplace, especially in the elderly (Hinchcliffe, 1961; Coles, Davis and Haggard, 198 1; OPCS Monitor, 1983). A minority of people who report tinnitus also complain of a variety of problems including mood disturbance, insomnia and the ‘intrusiveness’ of the noises (Tyler and Baker, 1983; Hallam, Rachman and Hinchcliffe, 1984; Hallam, 1986). A variety of factors have been implicated in the etiology of the disorder, but the underlying pathophysiology of tinnitus is not well-understood. Most methods of management are aimed at alleviating the distressing effects of tinnitus and the provision of hearing-aids, masking instruments and general advice have an important part to play in management (Stephens, 1984). Psychological interventions have been reviewed elsewhere (Hallam, 1986). Few controlled studies with adequate outcome measures have been reported. Combined with EMG biofeedback (Grassan, 1976; House, 1978) or with various cognitive techniques (Macleod-Morgan, Court and Roberts, 1982; Lyndberg, Lyttkens, Melin and Scott, 1984; Scott, Lyndberg, Lyttkens and Melin, 1986), relaxation training has been a favoured method. Tinnitus distress and disability are multidimensional consequences of tinnitus (Jakes, Hallam, Chambers and Hinchcliffe, 1985), and therefore it can be misleading to refer to ‘global im- provement’ in tinnitus severity. Intensity measures of tinnitus noises appear to change little with psychological therapy (Hallam and Jakes, 1985; Scott et zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPO al., 1986). Annoyance, however, can be reduced substantially. The technique of Scott and her colleagues included teaching the S to relax in response to a cue word, and instructing him to apply it in situations where distress was provoked. When relaxed, the S switched attention to an image of a pleasant scene. Changes in outcome measures were apparent only after therapy was introduced, and were most evident in respect of mood, and discomfort from tinnitus. The present study grew out of attempts to test an habituation model of tinnitus tolerance (Hallam et al., 1984). Pilot work failed to produce within-session benefits from listening to matched sounds in a relaxed state, but relaxation as such appeared to help some patients. A few patients B.R.T. ?.&%--A 491