Evaluating CBT and Meditation for Tinnitus

This assignment critically evaluates a research study investigating the effectiveness of Cognitive Behavioral Therapy (CBT) and meditation as treatments for chronic tinnitus. It analyzes both internal and external validity threats, considering factors like sample size, participant selection, and generalizability of findings. The analysis highlights the limitations of the study while acknowledging its contributions to understanding the potential benefits of psychosocial interventions for tinnitus sufferers.

Running head: RESEARCH AND EVIDENCE IN SCIENCE
Research and evidence in science
Name of the Student
Name of the University
Author note

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 The aim of the study was to examine and investigate the effects of meditation and
cognitive behavioural therapy (CBT) in tinnitus suffers (Sadlier, Stephens, & Kennedy,
2008). The nature of the study is wait list control group where there is group of
participants those are included in the outcome study assigned in waiting list and gives
intervention to the active group undergoing treatment. In this study, patients were
selected from the tinnitus clinic in the Welsh Hearing Institute where twenty-five chronic
tinnitus sufferers received CBT or meditation with four hour one sessions and the waiting
group received after three months in the same way. There were three hypothesis
proposed for the study. In the study, they hypothesized that recruitment of skeletal
muscle units, physical activity is controlled by pacing strategy within the CNS from
psychological and physiological systems based on feedback.
The first hypothesis was done regarding the nature and extent of disorder along
with complaint behaviour. Apart from psychosocial factors like emotional states,
behavioural dispositions and psychosocial factors, cognitive processes also have an effect
on the performance, physical function and exhaustion. It was also hypothesized that the
two groups would show improvement after the meditation or CBT intervention based on
control or active group. The treatment philosophy selected for the paper is Engel’s
biophychosocial approach that takes into account the personality, genetic vulnerability,
stress, behaviour, economy and supportive relationships. Based on this approach, it was
hypothesized that there are a large number of psychosocial stressors that are associated
with the onset or progression of tinnitus in the study.
 The method used for the study was waiting list control design. Twenty-five consecutive
patients suffering from tinnitus were selected who would benefit from CBT or meditation

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from Welsh Hearing Institute in Cardiff was invited for trail participation. Those patients
who did not want reassurance or had treatable cause like otitis media were excluded from
the study. The patients were selected who attended the clinic for the first time and felt
that audiological or psychological management approach entered the study. The first
group was treated with the intervention considered as active group with consultation from
audiological physician. The second group is the control group who waited for three
months for the treatment and therefore acted as control group. The active group consisted
of those patients who were assessed for tinnitus at the time of consultation for the first
time and after treatment whereas control or group two with a three month waiting prior to
starting of treatment.
Statistical comparisons was done where patients were given questionnaire at the
four to six month trial to rate their tinnitus in comparison to the post-treatment. The
hospital anxiety depression score was also measured pre-therapy and after the treatment.
Six measures assessed the tinnitus aspects that included perceived severity as well as
tinnitus impact on their mood and life. The measures taken were the Hallam tinnitus
questionnaire that measured the subjective severity, hospital anxiety and depression scale
to measure depression and anxiety in physically ill patients and Tinnitus visual analogue
scale (VAS) to measure the overall tinnitus effect on the life of the patient at present. The
satisfaction life scale was used to assess the patient’s views and perceptions while living
with tinnitus, Tinnitus triggers questionnaire to know about the stressors associated with
their tinnitus condition during onset or exacerbation of tinnitus. A questionnaire was also
sent to the patients during the four to six month intervention month to receive feedback o
how they felt after the treatment and provide comparison with options, ‘better’, ‘worse’

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or ‘no change’. All the four training sessions lasted for 40 minutes and data was analysed
through student t-tests and SPSS 11.5.
 The result regarding the tinnitus questionnaire from the beginning and end of the study in
the active group showed that there was highly significant change from beginning to end
in the group one. However, there was no change observed in the awaiting group as they
were awaiting treatment. There was significant change seen in the six parameters in
Hallam questionnaire where there were positive changes except for hearing. In control
group, there were no improvements pre-treatment however, there were significant results
seen in the post therapy. While measuring the hospital anxiety depression scale, pre-
treatment, it was 9.4 and it significantly 7.9 post-treatment for anxiety and 4.8 to 3.9 for
depression.
Tinnitus visual analogue scale for active group from pre to post treatment showed
highly significant changes (p < 0.007) and control group there was borderline change as
they were awaiting treatment (p < 0.053). The satisfaction rates with life questionnaire
showed that there were significant changes only in the control group where as there were
no significant changes in the active group. There were significant changes seen in two out
of five variables ‘satisfied with life’ (p=0.023), ‘conditions of life excellent’ (p=0.035)
and ‘life as ideal’ (p=0.053) showed borderline results. The tinnitus trigger questionnaire
results showed that in 77% of patients, stressful life events are associated with the
exacerbation or onset of tinnitus. The common factors were death or illness in the family
and retirement being occupational change. During the follow up between four to six
months, the return rate was 60%. Eighty percent of the patients (12) were feeling much
better after the post-treatment and there was no change in 20% of the participants.

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Between four to six months, there was a significant improvement in 12 patients seven
were experiencing significant improvements, three participants maintained the
improvement and two cases of worsened condition.
The study findings supported the hypothesis that psychosocial stressors are
associated with the onset or exacerbation of tinnitus like lifestyle, stress, social and
behaviour factors, supportive relationships like family and well-being. A number of
patients reported psychosocial stressors being associated with tinnitus among the
participants. The aim of the study was to evaluate effectiveness of CBT and meditation in
the treatment of tinnitus. The main findings showed significant results showing
improvement in the tinnitus sufferers. There was successful tinnitus management and
reduction in experiences of suffering with heightened awareness. Although, this study has
certain limitations, it is still effective in treating tinnitus and reduced their illness
sufferings.
 The validity concept in research is to evaluate that whether the test is valid or not and it
measured what they have claimed to measure (Diehl, Wahl, & Freund, 2017). The
participants were chosen that fulfilled the aim of the study like the tinnitus patients who
came to the clinic for the first time and monitored from four to six months during the
treatment trial. Internal validity is the measure of how well the research study has been
conducted that avoided confounding and possible independent variables (Shono, Ames,
& Stacy, 2016). There is proper evidence that claimed their results. The sample size was
manipulated, divided into two groups, control and active group in the research study as
the tinnitus variables showed significant results to reduce the potential threats. The
experimental treatment like CBT and meditation made a difference to the outcome that is

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it helped in the reduction of suffering in tinnitus patients. In both the active and control
groups, the tinnitus variables as well as the coping mechanisms and psychological
response can lead to amplification or dampening of the perpetuating tinnitus variables,
therefore to avoid potential threats in the research study, the treatment methods were
aimed at relieving the suffering, stress that is caused due to the tinnitus. The tinnitus
variables that were proposed for the active and control group showed significant results
before and after the treatment interventions except for the tinnitus effect on hearing. As
the control group was waiting for the treatment, there was no significant changes pre-
treatment, however showed significant results post-therapy apart from the relaxation
strategy.
External validity deals with the extent to which the research results can be
generalized to the people or other situations (Halperin, Pyne, & Martin, 2015). In other
words, the external validity is the extent to which there is a generalisation and causal
inference in the research study. The aim of the study was to evaluate the effectiveness of
CBT and meditation on the tinnitus sufferers. The main findings showed compliance with
the aim and hypothesis of the result where CBT and meditation is effective in the
treatment of chronic tinnitus to relieve them from their sufferings. This psychosocial
intervention is medically proved to relieve patients suffering from medically unexplained
symptoms.
 The restriction of the sample size through waiting list control design had a significant
effect on the research study. The sample size was small and therefore, it acted as a
preliminary study. To reduce the threat to validity, the authors had reduced the sample
size, which was not correct and so cause and effect relationship with causal inference and

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worth of understanding would have been used to get better outcomes (Csikszentmihalyi
& Larson, 2014). The consecutive basis of selection of the patient was a limitation of the
study as the external validity would have been limited as the patients represented the
tertiary referrals. This may not be applicable to other tinnitus patient sufferers. It is
evident that tinnitus is a common experience and not every patient requires treatment for
it. The research study sample comprised of patients who are distressed in tinnitus and so
it does not reflect general trends and pose problems due to waiting list control method for
specific therapist consultation.

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References
Csikszentmihalyi, M., & Larson, R. (2014). Validity and reliability of the experience-sampling
method. In Flow and the foundations of positive psychology. Springer Netherlands, 35-
54.
Diehl, M., Wahl, H. W., & Freund, A. (2017). Ecological Validity as a Key Feature of External
Validity in Research on Human Development. Research in Human Development, 177-
181.
Halperin, I., Pyne, D. B., & Martin, D. T. (2015). Threats to internal validity in exercise science:
a review of overlooked confounding variables. International journal of sports physiology
and performance, 823-829.
Sadlier, M., Stephens, S. D., & Kennedy, V. (2008). Tinnitus rehabilitation: a mindfulness
meditation cognitive behavioural therapy approach. The Journal of Laryngology &
Otology, 31-37.
Shono, Y., Ames, S. L., & Stacy, A. W. (2016). Evaluation of internal validity using modern test
theory: Application to word association. Psychological assessment, 194.